Basic Information
Provider Information
NPI: 1669695417
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: TOMPKINS
FirstName: MARY
MiddleName: ANN
NamePrefix:  
NameSuffix:  
Credential: APRN
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 1447 N HARRISON ST
Address2: STE 104
City: SAGINAW
State: MI
PostalCode: 486024727
CountryCode: US
TelephoneNumber: 9895834114
FaxNumber:  
Practice Location
Address1: 1447 N HARRISON ST
Address2:  
City: SAGINAW
State: MI
PostalCode: 486024727
CountryCode: US
TelephoneNumber: 9895834114
FaxNumber:  
Other Information
ProviderEnumerationDate: 04/10/2007
LastUpdateDate: 06/23/2016
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
363LF0000X4704141828MIY Physician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily

No ID Information.


Home