Provider Demographics
NPI:1497446496
Name:BANNERMAN, TANYA ANN (MSN, PMHNP-BC)
Entity type:Individual
Prefix:
First Name:TANYA
Middle Name:ANN
Last Name:BANNERMAN
Suffix:
Gender:F
Credentials:MSN, PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3600 N SAGINAW RD
Mailing Address - Street 2:
Mailing Address - City:MIDLAND
Mailing Address - State:MI
Mailing Address - Zip Code:48640-2301
Mailing Address - Country:US
Mailing Address - Phone:989-488-0936
Mailing Address - Fax:
Practice Address - Street 1:3600 N SAGINAW RD
Practice Address - Street 2:
Practice Address - City:MIDLAND
Practice Address - State:MI
Practice Address - Zip Code:48640-2301
Practice Address - Country:US
Practice Address - Phone:989-510-7626
Practice Address - Fax:989-486-1554
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-19
Last Update Date:2024-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704311189163W00000X, 363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163W00000XNursing Service ProvidersRegistered Nurse