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Individual

MRS. ELISE SHANNON PEANEY WILDERN

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
FNP-C

Contact information

Practice address
3404 PATIENT CARE DR, LANSING, MI 48911-4217
(517) 267-0200
Mailing address
137 CANTERBURY DR, CHARLOTTE, MI 48813-1038
(517) 896-7119

Taxonomy

Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
4704292079
MI

Other

Enumeration date
03/08/2021
Last updated
11/19/2023
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