Most Relevant Information
Provider Data
| NPI Number: | 1003513730 |
| Provider Name: | BRANDON MICHAEL TATAR MSN, APRN, ACCNS-AG |
| Entity Type: | Individual |
| Taxonomy Code: | 364SA2100X |
| Specialty: | Clinical Nurse Specialist |
| License Number: | 4704363198 |
Most Important Dates
| Enumeration Date: | 02/13/2023 |
| Last Updated: | 06/20/2023 |
Provider Practice Location
11800 E 12 MILE RD
WARREN
MI
480933472
Practice Location Phone/Fax
| Phone: | 5868541108 |
| Fax: |
Provider Mailing Location
53460 MEADOW VIEW LN
NEW BALTIMORE
MI
480475841
Provider Mailing Phone/Fax
| Phone: | 5868541108 |
| Fax: |