Healthcare Provider Details

I. General information

NPI: 1891959607
Provider Name (Legal Business Name): JANIS BRANTLEY RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/11/2008
Last Update Date: 07/11/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5400 EAST 7 MILE NORTHEAST HEALTH CENTER ROOM 17
DETROIT MI
48234
US

IV. Provider business mailing address

5400 EAST 7 MILE NORTHEAST HEALTH CENTER ROOM 17
DETROIT MI
48234
US

V. Phone/Fax

Practice location:
  • Phone: 313-870-3052
  • Fax: 313-368-4694
Mailing address:
  • Phone: 313-870-3052
  • Fax: 313-368-4694

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number4704163242
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: