Healthcare Provider Details

I. General information

NPI: 1043753254
Provider Name (Legal Business Name): ANNETTE TAYLOR FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ANN WIEBE

II. Dates (important events)

Enumeration Date: 11/21/2016
Last Update Date: 07/24/2025
Certification Date: 07/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1601 E KALAMAZOO ST
LANSING MI
48912-2701
US

IV. Provider business mailing address

PO BOX 30161
LANSING MI
48909-7661
US

V. Phone/Fax

Practice location:
  • Phone: 517-679-2880
  • Fax:
Mailing address:
  • Phone: 517-887-4383
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberF1016236
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: