Individual
LAURA FANNING
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
901 S OAKLAND ST STE 201, SAINT JOHNS, MI 48879-2200
(989) 224-2338
(989) 224-2065
Mailing address
PO BOX 13008, LANSING, MI 48901-3008
(989) 224-2338
(989) 224-2065
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
4704253569
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
4704253569
STATE LICENSE
MI
Enumeration date
06/26/2018
Last updated
06/26/2018
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