Basic Information
| Provider Information | |||||||||
| NPI: | 1639129646 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BILLMAN | ||||||||
| FirstName: | TYANN | ||||||||
| MiddleName: | R | ||||||||
| NamePrefix: | MRS. | ||||||||
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| Credential: | PA-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3785 BAY RD | ||||||||
| Address2: | |||||||||
| City: | SAGINAW | ||||||||
| State: | MI | ||||||||
| PostalCode: | 486032433 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9897912455 | ||||||||
| FaxNumber: | 9897911392 | ||||||||
| Practice Location | |||||||||
| Address1: | 735 E CHICAGO RD | ||||||||
| Address2: | |||||||||
| City: | BRONSON | ||||||||
| State: | MI | ||||||||
| PostalCode: | 490281349 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5178581400 | ||||||||
| FaxNumber: | 5178581403 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/11/2006 | ||||||||
| LastUpdateDate: | 11/13/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363A00000X | 5601003977 | MI | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant |
ID Information
| ID | Type | State | Issuer | Description | 34335 | 05 | MI | MEDICAID | 5120031 | 01 | MI | BCBSM | OTHER | 105519 | 01 | MI | NCCPA | OTHER | MI4324001 | 01 | MI | MEDICARE PTAN | OTHER | 2467525361 | 01 | MI | US DEPT OF TRANSPORTATION | OTHER |