Provider Demographics
NPI:1497174601
Name:GARNER, TANCHONWAA (LPN)
Entity Type:Individual
Prefix:
First Name:TANCHONWAA
Middle Name:
Last Name:GARNER
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21586 SHEFFIELD DR
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48335-5461
Mailing Address - Country:US
Mailing Address - Phone:248-943-6131
Mailing Address - Fax:
Practice Address - Street 1:21586 SHEFFIELD DR
Practice Address - Street 2:
Practice Address - City:FARMINGTON HILLS
Practice Address - State:MI
Practice Address - Zip Code:48335-5461
Practice Address - Country:US
Practice Address - Phone:248-943-6131
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-04-15
Last Update Date:2014-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4703104681164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse