Provider Demographics
NPI:1346135761
Name:LETSON, TINA M (CHW)
Entity type:Individual
Prefix:
First Name:TINA
Middle Name:M
Last Name:LETSON
Suffix:
Gender:F
Credentials:CHW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 310
Mailing Address - Street 2:
Mailing Address - City:TAWAS CITY
Mailing Address - State:MI
Mailing Address - Zip Code:48764-0310
Mailing Address - Country:US
Mailing Address - Phone:989-387-4045
Mailing Address - Fax:
Practice Address - Street 1:PO BOX 310
Practice Address - Street 2:
Practice Address - City:TAWAS CITY
Practice Address - State:MI
Practice Address - Zip Code:48764-0310
Practice Address - Country:US
Practice Address - Phone:989-387-4045
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-06-09
Last Update Date:2025-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI145282141172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker