Healthcare Provider Details

I. General information

NPI: 1508468257
Provider Name (Legal Business Name): NICOLE LYNN VASHER PMHNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/09/2020
Last Update Date: 01/23/2026
Certification Date: 01/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3475 BELLE CHASE WAY
LANSING MI
48911-4252
US

IV. Provider business mailing address

298 HIGHLAND ST
WYANDOTTE MI
48192-2542
US

V. Phone/Fax

Practice location:
  • Phone: 517-744-7389
  • Fax: 517-882-3633
Mailing address:
  • Phone: 734-799-3940
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number4704274540
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: