Individual
TIARA WYCKOFF
Active
Sole proprietor
No
Provider details
NPI number
Gender
X
Contact information
Practice address
117 MOORES RIVER DR, LANSING, MI 48910-1472
(248) 954-8199
Mailing address
117 MOORES RIVER DR, LANSING, MI 48910-1472
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
4703130141
MI
Other
Enumeration date
04/01/2026
Last updated
04/01/2026
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