Provider Demographics
NPI:1083376875
Name:LANNING, MICHELLE (PMHNP-BC, ARNP)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:
Last Name:LANNING
Suffix:
Gender:F
Credentials:PMHNP-BC, ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3422 ADELINE CT SW
Mailing Address - Street 2:
Mailing Address - City:CEDAR RAPIDS
Mailing Address - State:IA
Mailing Address - Zip Code:52404-1313
Mailing Address - Country:US
Mailing Address - Phone:319-981-9211
Mailing Address - Fax:
Practice Address - Street 1:3422 ADELINE CT SW
Practice Address - Street 2:
Practice Address - City:CEDAR RAPIDS
Practice Address - State:IA
Practice Address - Zip Code:52404-1313
Practice Address - Country:US
Practice Address - Phone:319-981-9211
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-08
Last Update Date:2021-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAG165954363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health