Provider Demographics
NPI:1497729461
Name:TANSKI, THERESE (CRNA)
Entity Type:Individual
Prefix:
First Name:THERESE
Middle Name:
Last Name:TANSKI
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:46236 BARRINGTON RD
Mailing Address - Street 2:
Mailing Address - City:PLYMOUTH
Mailing Address - State:MI
Mailing Address - Zip Code:48170-3503
Mailing Address - Country:US
Mailing Address - Phone:734-776-1071
Mailing Address - Fax:
Practice Address - Street 1:47601 GRAND RIVER AVE
Practice Address - Street 2:
Practice Address - City:NOVI
Practice Address - State:MI
Practice Address - Zip Code:48374-1233
Practice Address - Country:US
Practice Address - Phone:248-465-4100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-02-15
Last Update Date:2019-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX561897367500000X
MI4704263809367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX002420004Medicaid
TX002420002Medicaid
TX561897OtherRN LICENSE
P00145819OtherMEDICARE RAILROAD
S99887Medicare UPIN
8C6068Medicare PIN
TX561897OtherRN LICENSE
TX002420004Medicaid