Provider Demographics
NPI:1538579289
Name:NIMS, TATYANA
Entity type:Individual
Prefix:
First Name:TATYANA
Middle Name:
Last Name:NIMS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1195 M 89
Mailing Address - Street 2:
Mailing Address - City:PLAINWELL
Mailing Address - State:MI
Mailing Address - Zip Code:49080-1135
Mailing Address - Country:US
Mailing Address - Phone:269-685-3833
Mailing Address - Fax:269-685-3765
Practice Address - Street 1:1195 M 89
Practice Address - Street 2:
Practice Address - City:PLAINWELL
Practice Address - State:MI
Practice Address - Zip Code:49080-1135
Practice Address - Country:US
Practice Address - Phone:269-685-3833
Practice Address - Fax:269-685-3765
Is Sole Proprietor?:No
Enumeration Date:2014-05-03
Last Update Date:2014-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI53020355061835P1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P1200XPharmacy Service ProvidersPharmacistPharmacotherapy