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General NPI Number Information
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NPI Number | 1497446496
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Entity Type | Individual
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Provider Name | TANYA ANN BANNERMAN MSN, PMHNP-BC
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Gender | Female
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Dates
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Enumeration Date | 05/19/2023
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Last Update Date | 11/07/2024
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Provider Practice Location Address
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Address Line | 3600 N SAGINAW RD
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City | MIDLAND
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State | MI
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Zip | 48640-2301
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Country | US
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Telephone | 989-510-7626
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Fax | 989-486-1554
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Provider Business Mailing Address
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Address Line | 3600 N SAGINAW RD
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City | MIDLAND
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State | MI
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Zip | 48640-2301
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Country | US
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Telephone | 989-488-0936
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 4704311189
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License Number State | MI
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Taxonomy #2
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | 4704311189
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License Number State | MI
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