Provider Demographics
NPI:1639129646
Name:BILLMAN, TYANN R (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:TYANN
Middle Name:R
Last Name:BILLMAN
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
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Mailing Address - Street 1:3785 BAY RD
Mailing Address - Street 2:
Mailing Address - City:SAGINAW
Mailing Address - State:MI
Mailing Address - Zip Code:48603-2433
Mailing Address - Country:US
Mailing Address - Phone:989-791-2455
Mailing Address - Fax:989-791-1392
Practice Address - Street 1:735 E CHICAGO RD
Practice Address - Street 2:
Practice Address - City:BRONSON
Practice Address - State:MI
Practice Address - Zip Code:49028-1349
Practice Address - Country:US
Practice Address - Phone:517-858-1400
Practice Address - Fax:517-858-1403
Is Sole Proprietor?:No
Enumeration Date:2006-05-11
Last Update Date:2018-11-13
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI5601003977363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI34335Medicaid
MI5120031OtherBCBSM
MI105519OtherNCCPA
MIMI4324001OtherMEDICARE PTAN
MI2467525361OtherUS DEPT OF TRANSPORTATION