MEDICARE: TIARA WYCKOFF

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	164W00000X	Licensed Practical Nurse	4703130141	MI

General Provider Information

NPI Number	:	1255271763
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TIARA WYCKOFF

Provider Business Mailing Address
First Line	:	117 MOORES RIVER DR
Second Line	:
City	:	LANSING
State	:	MI
Zip	:	48910-1472
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	117 MOORES RIVER DR
Second Line	:
City	:	LANSING
State	:	MI
Zip	:	48910-1472
Country	:	US
Telephone Number	:	248-954-8199
Fax Number	:

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

Provider Enumeration Date	:	04/01/2026
Last Update Date	:	04/01/2026

Similar Medicare Providers

1528908811 — MAGNIFY SERVICES INC
Practice Location Address:

1726 TEEL AVE
LANSING, MI
48910-9116

Practice Phone: 517-489-2729
Practice Fax: 517-220-2103

1447190020 — VIRTUAL WELLNESS CARE, LLC
Practice Location Address:

405 W GREENLAWN AVE STE G11
LANSING, MI
48910-2889

Practice Phone: 313-346-4240
Practice Fax: 313-346-4241

1922948520 — E&C TRANS LLC
Practice Location Address:

2107 S WASHINGTON AVE
LANSING, MI
48910-2862

Practice Phone: 314-297-7228
Practice Fax:

1023846060 — ISHIMWE CIZA ERIC
Practice Location Address:

2107 S WASHINGTON AVE
LANSING, MI
48910-2862

Practice Phone: 314-297-7228
Practice Fax:

1780525881 — JESSICA SHEVELAND
Practice Location Address:

901 E MOUNT HOPE AVE
LANSING, MI
48910-3207

Practice Phone: 517-999-2760
Practice Fax:

1275214637 — GRACELYNN MAIKE
Practice Location Address:

901 E MOUNT HOPE AVE
LANSING, MI
48910-3207

Practice Phone: 517-999-2760
Practice Fax:

Directions to “ TIARA WYCKOFF ” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.