Healthcare Provider Details

I. General information

NPI: 1548074040
Provider Name (Legal Business Name): EBONY LATICE BRIGGS C.N.A
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/04/2025
Last Update Date: 02/04/2025
Certification Date: 02/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1525 SYLVAN AVE SE
GRAND RAPIDS MI
49506-3940
US

IV. Provider business mailing address

1525 SYLVAN AVE SE
GRAND RAPIDS MI
49506-3940
US

V. Phone/Fax

Practice location:
  • Phone: 616-719-6473
  • Fax:
Mailing address:
  • Phone: 616-719-6473
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code376K00000X
TaxonomyNurse's Aide
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: