1619753464 NPI number — MRS. TAMMY SZOSTAKOWSKI LAFAIVE CNM

Table of content: MRS. TAMMY SZOSTAKOWSKI LAFAIVE CNM (NPI 1619753464)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1619753464 NPI number — MRS. TAMMY SZOSTAKOWSKI LAFAIVE CNM

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LAFAIVE
Provider First Name:
TAMMY
Provider Middle Name:
SZOSTAKOWSKI
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
CNM
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
SZOSTAKOWSKI
Provider Other First Name:
TAMMY
Provider Other Middle Name:
LYNN
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
RN
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1619753464
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/29/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
CAMPUS RIDGE BUILDING
Provider Second Line Business Mailing Address:
4401 CAMPUS RIDGE DRIVE SUITE LL0110
Provider Business Mailing Address City Name:
MIDLAND
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48640
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
989-837-9400
Provider Business Mailing Address Fax Number:
989-837-9410

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
CAMPUS RIDGE BUILDING 4401 CAMPUS RIDGE DRIVE
Provider Second Line Business Practice Location Address:
SUITE LL0110
Provider Business Practice Location Address City Name:
MIDLAND
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48640
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
989-837-9400
Provider Business Practice Location Address Fax Number:
989-837-9410
Provider Enumeration Date:
09/07/2023

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 367A00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207VX0000X , with the licence number: 4704217144 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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