Healthcare Provider Details

I. General information

NPI: 1417849100
Provider Name (Legal Business Name): LYNETTE SANDAY
Entity Type: Individual
Gender:
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/17/2025
Last Update Date: 07/17/2025
Certification Date: 07/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5151 MARTIN RD
MUSSEY MI
48014-1712
US

IV. Provider business mailing address

5151 MARTIN RD
MUSSEY MI
48014-1712
US

V. Phone/Fax

Practice location:
  • Phone: 810-531-2399
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License Number4703093695
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: