MEDICARE: WISAM ROBERT ZEINEH RN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	47044393945	MI
2	363LF0000X	Family Nurse Practitioner	A188428	IA

General Provider Information

NPI Number	:	1255120820
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	WISAM ROBERT ZEINEH RN

Provider Business Mailing Address
First Line	:	2504 E MICHIGAN AVE
Second Line	:
City	:	LANSING
State	:	MI
Zip	:	48912-4011
Country	:	US
Telephone Number	:	517-268-0889
Fax Number	:

Provider Business Practice Location Address
First Line	:	2504 E MICHIGAN AVE
Second Line	:
City	:	LANSING
State	:	MI
Zip	:	48912-4011
Country	:	US
Telephone Number	:	517-268-0889
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/01/2025
Last Update Date	:	12/18/2025

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