Healthcare Provider Details

I. General information

NPI: 1538517339
Provider Name (Legal Business Name): SENORA HYLAND
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/02/2016
Last Update Date: 06/25/2021
Certification Date: 06/25/2021
Deactivation Date: 05/28/2019
Reactivation Date: 06/25/2021

III. Provider practice location address

1943 MENDOTA DR
EAST LANSING MI
48823-1447
US

IV. Provider business mailing address

1943 MENDOTA DR
EAST LANSING MI
48823-1447
US

V. Phone/Fax

Practice location:
  • Phone: 517-652-4687
  • Fax:
Mailing address:
  • Phone: 517-652-4687
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code247200000X
TaxonomyOther Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: