Provider Demographics
NPI:1619753464
Name:LAFAIVE, TAMMY SZOSTAKOWSKI (CNM)
Entity Type:Individual
Prefix:MRS
First Name:TAMMY
Middle Name:SZOSTAKOWSKI
Last Name:LAFAIVE
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:TAMMY
Other - Middle Name:LYNN
Other - Last Name:SZOSTAKOWSKI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:CAMPUS RIDGE BUILDING
Mailing Address - Street 2:4401 CAMPUS RIDGE DRIVE SUITE LL0110
Mailing Address - City:MIDLAND
Mailing Address - State:MI
Mailing Address - Zip Code:48640
Mailing Address - Country:US
Mailing Address - Phone:989-837-9400
Mailing Address - Fax:989-837-9410
Practice Address - Street 1:CAMPUS RIDGE BUILDING 4401 CAMPUS RIDGE DRIVE
Practice Address - Street 2:SUITE LL0110
Practice Address - City:MIDLAND
Practice Address - State:MI
Practice Address - Zip Code:48640
Practice Address - Country:US
Practice Address - Phone:989-837-9400
Practice Address - Fax:989-837-9410
Is Sole Proprietor?:No
Enumeration Date:2023-09-07
Last Update Date:2024-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
367A00000X
MI4704217144207VX0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VX0000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyObstetrics
No367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife