Healthcare Provider Details

I. General information

NPI: 1508618562
Provider Name (Legal Business Name): BRANDI HAYWOOD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/03/2024
Last Update Date: 04/03/2024
Certification Date: 04/03/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12411 E 7 MILE RD
DETROIT MI
48205-2154
US

IV. Provider business mailing address

27661 WOODMONT ST
ROSEVILLE MI
48066-2726
US

V. Phone/Fax

Practice location:
  • Phone: 313-526-3460
  • Fax:
Mailing address:
  • Phone: 313-207-7942
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: