Provider Demographics
NPI:1609217660
Name:LAINESSE, VICKI M (NP)
Entity Type:Individual
Prefix:
First Name:VICKI
Middle Name:M
Last Name:LAINESSE
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:VICKI
Other - Middle Name:M
Other - Last Name:SCHWAB
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:1504 E GRAND RIVER AVE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:EAST LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48823
Mailing Address - Country:US
Mailing Address - Phone:517-908-3040
Mailing Address - Fax:517-908-0856
Practice Address - Street 1:1504 E GRAND RIVER AVE
Practice Address - Street 2:SUITE 100
Practice Address - City:EAST LANSING
Practice Address - State:MI
Practice Address - Zip Code:48823
Practice Address - Country:US
Practice Address - Phone:517-908-3040
Practice Address - Fax:517-908-0856
Is Sole Proprietor?:No
Enumeration Date:2013-07-08
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704246582363L00000X, 363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner