Provider Demographics
NPI:1053735506
Name:STREETER, TINA (CNA)
Entity type:Individual
Prefix:MRS
First Name:TINA
Middle Name:
Last Name:STREETER
Suffix:
Gender:F
Credentials:CNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2816 IROQUOIS AVE
Mailing Address - Street 2:
Mailing Address - City:FLINT
Mailing Address - State:MI
Mailing Address - Zip Code:48505-4042
Mailing Address - Country:US
Mailing Address - Phone:810-308-1180
Mailing Address - Fax:
Practice Address - Street 1:2816 IROQUOIS AVE
Practice Address - Street 2:
Practice Address - City:FLINT
Practice Address - State:MI
Practice Address - Zip Code:48505-4042
Practice Address - Country:US
Practice Address - Phone:810-308-1180
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-02-04
Last Update Date:2014-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health