Provider Demographics
NPI:1497414619
Name:CRUMP, TANISHA LANAI
Entity Type:Individual
Prefix:
First Name:TANISHA
Middle Name:LANAI
Last Name:CRUMP
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 1:24576 ORANGELAWN
Mailing Address - Street 2:24576 ORANGELAWN
Mailing Address - City:REDFORD
Mailing Address - State:MI
Mailing Address - Zip Code:48239
Mailing Address - Country:US
Mailing Address - Phone:313-828-7756
Mailing Address - Fax:
Practice Address - Street 1:24576 ORANGELAWN
Practice Address - Street 2:24576 ORANGELAWN
Practice Address - City:REDFORD
Practice Address - State:MI
Practice Address - Zip Code:48239
Practice Address - Country:US
Practice Address - Phone:313-828-7756
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-12-15
Last Update Date:2021-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes372500000XNursing Service Related ProvidersChore Provider
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIC651785488138Medicaid