Healthcare Provider Details

I. General information

NPI: 1295297240
Provider Name (Legal Business Name): BRIANNA KUHATSCHEK
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: BRIANNA CHRENKO

II. Dates (important events)

Enumeration Date: 04/01/2019
Last Update Date: 01/16/2022
Certification Date: 01/16/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3292 N EVERGREEN DR NE
GRAND RAPIDS MI
49525-9746
US

IV. Provider business mailing address

524 3 MILE RD NE
GRAND RAPIDS MI
49505-3345
US

V. Phone/Fax

Practice location:
  • Phone: 616-365-8920
  • Fax: 616-365-8971
Mailing address:
  • Phone: 248-756-6009
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-19-34808
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: