Tisha Antoniszczak, RN

Primary specialty

Addiction (Substance Use Disorder) Registered NurseTaxonomy code 163WA0400X

License

4704312568 Issued in MI

Practice address

630 Walnut St
Alpena, MI 49707-1832

Phone

(989) 356-6649

Fax

(989) 356-3559

NPI assigned

Jan 25, 2022

Last updated

Jan 25, 2022By the provider in NPPES

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Registered Nurse

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Sunrise Centre Inc

  • Substance Abuse Rehabilitation Facility
  • Alpena, MI
  • NPI 1235297623
  NPD (past)
• Sunrise Centre, Inc

  • Community/Behavioral Health Agency
  • Alpena, MI
  • NPI 1023556099
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1643068800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1643068800000",
    "number": "1821740325",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "630 WALNUT ST",
            "city": "ALPENA",
            "state": "MI",
            "postal_code": "497071832",
            "telephone_number": "989-356-6649",
            "fax_number": "989-356-3559"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "630 WALNUT ST",
            "city": "ALPENA",
            "state": "MI",
            "postal_code": "497071832",
            "telephone_number": "989-356-6649",
            "fax_number": "989-356-3559"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ANTONISZCZAK",
        "first_name": "TISHA",
        "credential": "RN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2022-01-25",
        "last_updated": "2022-01-25",
        "certification_date": "2022-01-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163WA0400X",
            "taxonomy_group": "",
            "desc": "Registered Nurse, Addiction (Substance Use Disorder)",
            "state": "MI",
            "license": "4704312568",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE OF MICHIGAN",
            "identifier": "4704312568",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Dawn Anderson
• Elwood G Anderson, ED.D
• Mari Lee Anderson, FNP-C
• Andrew C. Tarkington D.D.S. ,P.C.
• James Robert Antkowiak, PHARMD
• Apex Drug Stores Inc (Rite Aid Pharmacy 04532)
• Shay Appold, LPTA
• Mykul Richard Archer, CADC-DP
• Monika Arora, M.D.
• Sanjeev Arora, M.D.

• Addiction (Substance Use Disorder) Registered Nurse in Alpena, MI
• Providers in Alpena, MI by specialty
• Addiction (Substance Use Disorder) Registered Nurse in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 25, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.