Provider Demographics
NPI:1063773620
Name:TWEEDLY, ELIZABETH MARY (LPN)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:MARY
Last Name:TWEEDLY
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:32500 CONCORD DR
Mailing Address - Street 2:
Mailing Address - City:MADISON HTS
Mailing Address - State:MI
Mailing Address - Zip Code:48071-1100
Mailing Address - Country:US
Mailing Address - Phone:866-876-2747
Mailing Address - Fax:586-620-6040
Practice Address - Street 1:32500 CONCORD DR
Practice Address - Street 2:
Practice Address - City:MADISON HTS
Practice Address - State:MI
Practice Address - Zip Code:48071-1100
Practice Address - Country:US
Practice Address - Phone:866-876-2747
Practice Address - Fax:586-620-6040
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-30
Last Update Date:2012-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4703107216164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse