Provider Demographics
NPI:1922473941
Name:WILLINGHAM-TUBBS, MICHELLE RENEE (RN CCM)
Entity Type:Individual
Prefix:MS
First Name:MICHELLE
Middle Name:RENEE
Last Name:WILLINGHAM-TUBBS
Suffix:
Gender:F
Credentials:RN CCM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14680 JULIANA AVE
Mailing Address - Street 2:
Mailing Address - City:EASTPOINTE
Mailing Address - State:MI
Mailing Address - Zip Code:48021-2840
Mailing Address - Country:US
Mailing Address - Phone:947-800-9035
Mailing Address - Fax:
Practice Address - Street 1:14680 JULIANA AVE
Practice Address - Street 2:
Practice Address - City:EASTPOINTE
Practice Address - State:MI
Practice Address - Zip Code:48021-2840
Practice Address - Country:US
Practice Address - Phone:586-350-8829
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-12-02
Last Update Date:2023-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9380366163WC0400X
171400000X
MI4704186652163WC0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC0400XNursing Service ProvidersRegistered NurseCase Management
No171400000XOther Service ProvidersHealth & Wellness Coach