MEDICARE: VANESSA TEAL LANDRUM CNM

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	163WM0102X	Maternal Newborn Registered Nurse	4704314219	MI
2	367A00000X	Advanced Practice Midwife
3	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	1346866480	MI
4	367A00000X	Advanced Practice Midwife	4704314219	MI

General Provider Information

NPI Number	:	1346866480
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	VANESSA TEAL LANDRUM CNM

Provider Business Mailing Address
First Line	:	8575 HERITAGE PL
Second Line	:
City	:	DETROIT
State	:	MI
Zip	:	48204-2326
Country	:	US
Telephone Number	:	313-919-5965
Fax Number	:

Provider Business Practice Location Address
First Line	:	8575 HERITAGE PL
Second Line	:
City	:	DETROIT
State	:	MI
Zip	:	48204-2326
Country	:	US
Telephone Number	:	313-919-5965
Fax Number	:

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

Provider Enumeration Date	:	06/24/2020
Last Update Date	:	03/11/2026

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