Healthcare Provider Details

I. General information

NPI: 1013043256
Provider Name (Legal Business Name): BRIGHT CONNECTION INFUSION CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/24/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

418 E GRAND BLVD
DETROIT MI
48207-3619
US

IV. Provider business mailing address

400 E GRAND BLVD
DETROIT MI
48207-3619
US

V. Phone/Fax

Practice location:
  • Phone: 313-267-0603
  • Fax:
Mailing address:
  • Phone: 313-778-5683
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WI0500X
TaxonomyInfusion Therapy Registered Nurse
License Number4704229459
License Number StateMI

VIII. Authorized Official

Name: MRS. DONNA NEALOUS BROWN
Title or Position: REGISTERED NURSE
Credential:
Phone: 313-778-5683