Provider Demographics
NPI:1720888670
Name:TANIN, THERESA (MASCN)
Entity type:Individual
Prefix:
First Name:THERESA
Middle Name:
Last Name:TANIN
Suffix:
Gender:
Credentials:MASCN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:582 ARCHWOOD DR
Mailing Address - Street 2:
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48103-2805
Mailing Address - Country:US
Mailing Address - Phone:248-994-1892
Mailing Address - Fax:
Practice Address - Street 1:582 ARCHWOOD DR
Practice Address - Street 2:
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48103-2805
Practice Address - Country:US
Practice Address - Phone:248-994-1892
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-03-18
Last Update Date:2025-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133NN1002XDietary & Nutritional Service ProvidersNutritionistNutrition, Education