Provider Demographics
NPI:1710209218
Name:LANDER, ELLEN F (MSN, APRN, BC)
Entity Type:Individual
Prefix:
First Name:ELLEN
Middle Name:F
Last Name:LANDER
Suffix:
Gender:F
Credentials:MSN, APRN, BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10889 CANTERBURY LN
Mailing Address - Street 2:
Mailing Address - City:GRAND LEDGE
Mailing Address - State:MI
Mailing Address - Zip Code:48837-9478
Mailing Address - Country:US
Mailing Address - Phone:517-887-4467
Mailing Address - Fax:517-244-7174
Practice Address - Street 1:2316 S CEDAR ST
Practice Address - Street 2:
Practice Address - City:LANSING
Practice Address - State:MI
Practice Address - Zip Code:48910-3152
Practice Address - Country:US
Practice Address - Phone:517-887-4302
Practice Address - Fax:517-887-4437
Is Sole Proprietor?:No
Enumeration Date:2010-02-24
Last Update Date:2017-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704198063363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health