Provider Demographics
NPI:1770282733
Name:MARTIN, TYRESHA MONIQUE
Entity type:Individual
Prefix:
First Name:TYRESHA
Middle Name:MONIQUE
Last Name:MARTIN
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 1:3716 NEWBERRY ST UNIT 365
Mailing Address - Street 2:
Mailing Address - City:WAYNE
Mailing Address - State:MI
Mailing Address - Zip Code:48184-3716
Mailing Address - Country:US
Mailing Address - Phone:313-407-1796
Mailing Address - Fax:
Practice Address - Street 1:30789 KRAUTER ST
Practice Address - Street 2:
Practice Address - City:GARDEN CITY
Practice Address - State:MI
Practice Address - Zip Code:48135-1863
Practice Address - Country:US
Practice Address - Phone:313-407-1796
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-28
Last Update Date:2023-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes372500000XNursing Service Related ProvidersChore Provider