Healthcare Provider Details

I. General information

NPI: 1326138330
Provider Name (Legal Business Name): MICHELE LYNNETTE BRANNAN PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/13/2006
Last Update Date: 12/31/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13191 SCHAVEY RD SUTIE 3
DEWITT MI
48820-9036
US

IV. Provider business mailing address

PO BOX 13008
LANSING MI
48901-3008
US

V. Phone/Fax

Practice location:
  • Phone: 517-669-9109
  • Fax: 517-669-9839
Mailing address:
  • Phone: 517-364-6253
  • Fax: 517-364-6204

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number4601003009
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: