Provider Demographics
NPI:1720499296
Name:ATWOOD, TONYA
Entity type:Individual
Prefix:
First Name:TONYA
Middle Name:
Last Name:ATWOOD
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 1:315 GROVE ST
Mailing Address - Street 2:
Mailing Address - City:HUDSON
Mailing Address - State:MI
Mailing Address - Zip Code:49247-1213
Mailing Address - Country:US
Mailing Address - Phone:517-398-0287
Mailing Address - Fax:517-306-6016
Practice Address - Street 1:315 GROVE ST
Practice Address - Street 2:
Practice Address - City:HUDSON
Practice Address - State:MI
Practice Address - Zip Code:49247-1213
Practice Address - Country:US
Practice Address - Phone:517-398-0287
Practice Address - Fax:517-306-6016
Is Sole Proprietor?:Yes
Enumeration Date:2014-05-18
Last Update Date:2014-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI230015341500311172V00000X
MIG5T2D5K73747P1801X
MID8N9M3X2374U00000X
MIZ4B4W6D2374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
No172V00000XOther Service ProvidersCommunity Health Worker
No3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI223682527061414041OtherEFTPS INQUIRY PIN
MI46-3569525OtherEIN