Provider Demographics
NPI:1497446496
Name:BANNERMAN, TANYA ANN (RN)
Entity Type:Individual
Prefix:
First Name:TANYA
Middle Name:ANN
Last Name:BANNERMAN
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3013 CAMBERLEY LN
Mailing Address - Street 2:
Mailing Address - City:MIDLAND
Mailing Address - State:MI
Mailing Address - Zip Code:48640-2401
Mailing Address - Country:US
Mailing Address - Phone:989-488-0936
Mailing Address - Fax:
Practice Address - Street 1:3013 CAMBERLEY LN
Practice Address - Street 2:
Practice Address - City:MIDLAND
Practice Address - State:MI
Practice Address - Zip Code:48640-2401
Practice Address - Country:US
Practice Address - Phone:989-488-0936
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-19
Last Update Date:2023-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704311189163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse