Healthcare Provider Details

I. General information

NPI: 1013811298
Provider Name (Legal Business Name): TANIKKA MARIE SLOWE PMHNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/02/2026
Last Update Date: 10/02/2026
Certification Date: 10/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 W TOWNSEND RD
SAINT JOHNS MI
48879-9200
US

IV. Provider business mailing address

125 W CESAR E CHAVEZ AVE APT 2
LANSING MI
48906-4860
US

V. Phone/Fax

Practice location:
  • Phone: 989-403-6022
  • Fax:
Mailing address:
  • Phone: 989-403-6022
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number4704411544
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: