Healthcare Provider Details

I. General information

NPI: 1316708282
Provider Name (Legal Business Name): BRIANNA RAHN PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: BRIANNA WISTI PA-C

II. Dates (important events)

Enumeration Date: 01/18/2024
Last Update Date: 02/21/2024
Certification Date: 02/21/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

56720 CALUMET AVE
CALUMET MI
49913-1904
US

IV. Provider business mailing address

48284 LARSON RD
ATLANTIC MINE MI
49905-9208
US

V. Phone/Fax

Practice location:
  • Phone: 906-483-1177
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number5601012230
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: