Provider Demographics
NPI:1740655901
Name:TANIS, JEAN TASHINA
Entity type:Individual
Prefix:MRS
First Name:JEAN
Middle Name:TASHINA
Last Name:TANIS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:35425 W MICHIGAN AVE
Mailing Address - Street 2:
Mailing Address - City:WAYNE
Mailing Address - State:MI
Mailing Address - Zip Code:48184-9800
Mailing Address - Country:US
Mailing Address - Phone:734-467-7600
Mailing Address - Fax:734-467-7636
Practice Address - Street 1:2944 FULLER AVE NE
Practice Address - Street 2:SUITE 301
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49505-3784
Practice Address - Country:US
Practice Address - Phone:616-284-5871
Practice Address - Fax:616-774-1001
Is Sole Proprietor?:No
Enumeration Date:2015-12-14
Last Update Date:2024-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator