Provider Demographics
NPI:1245770528
Name:TENNANT, KATHLEEN CYNTHINA-ELIZABETH
Entity Type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:CYNTHINA-ELIZABETH
Last Name:TENNANT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4170 W BATTLE RD
Mailing Address - Street 2:
Mailing Address - City:FARWELL
Mailing Address - State:MI
Mailing Address - Zip Code:48622-9211
Mailing Address - Country:US
Mailing Address - Phone:989-309-9048
Mailing Address - Fax:
Practice Address - Street 1:4170 W BATTLE RD
Practice Address - Street 2:
Practice Address - City:FARWELL
Practice Address - State:MI
Practice Address - Zip Code:48622-9211
Practice Address - Country:US
Practice Address - Phone:989-309-9048
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-06
Last Update Date:2017-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide