Healthcare Provider Details

I. General information

NPI: 1760614721
Provider Name (Legal Business Name): MEGAN M BRONSON PMHCNS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/10/2009
Last Update Date: 08/10/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4877 MEANDERING CREEK DR NE
BELMONT MI
49306-9662
US

IV. Provider business mailing address

4877 MEANDERING CREEK DR NE
BELMONT MI
49306-9662
US

V. Phone/Fax

Practice location:
  • Phone: 616-874-7014
  • Fax: 616-874-8661
Mailing address:
  • Phone: 616-874-7014
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code364SP0809X
TaxonomyAdult Psychiatric/Mental Health Clinical Nurse Specialist
License Number4704075894
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: