Healthcare Provider Details

I. General information

NPI: 1811276231
Provider Name (Legal Business Name): BRITTNEY NICHOLE MCCORMACK PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: BRITTNEY N FELSKE PA-C

II. Dates (important events)

Enumeration Date: 08/16/2011
Last Update Date: 11/26/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1500 EAST MEDICAL CENTER DR B1 FLOOR UNIVERSITY HOSPITAL RECP EMERGENCY
ANN ARBOR MI
48109-5301
US

IV. Provider business mailing address

3621 SOUTH STATE STREET 700 KMS PLACE
ANN ARBOR MI
48108
US

V. Phone/Fax

Practice location:
  • Phone: 734-936-6666
  • Fax: 734-232-1218
Mailing address:
  • Phone: 734-936-2047
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number5601006167
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: