Provider Demographics
NPI:1497570550
Name:TENYER, REBECCA (FNP-C)
Entity type:Individual
Prefix:MRS
First Name:REBECCA
Middle Name:
Last Name:TENYER
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:MRS
Other - First Name:REBECCA
Other - Middle Name:
Other - Last Name:FRICKERT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4577 MCKINLEY RD
Mailing Address - Street 2:
Mailing Address - City:CHINA
Mailing Address - State:MI
Mailing Address - Zip Code:48054-3101
Mailing Address - Country:US
Mailing Address - Phone:810-278-0329
Mailing Address - Fax:
Practice Address - Street 1:1943 HOLLAND AVE
Practice Address - Street 2:
Practice Address - City:PORT HURON
Practice Address - State:MI
Practice Address - Zip Code:48060-1519
Practice Address - Country:US
Practice Address - Phone:810-985-5700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-11-22
Last Update Date:2024-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704342734363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily