Healthcare Provider Details

I. General information

NPI: 1053160234
Provider Name (Legal Business Name): BRYNN ECKLUND PMHNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: BRYNN CARLSON

II. Dates (important events)

Enumeration Date: 05/18/2024
Last Update Date: 05/07/2026
Certification Date: 05/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

56466 BEAR LAKE RD
HANCOCK MI
49930-9640
US

IV. Provider business mailing address

PO BOX 103
CALUMET MI
49913-0103
US

V. Phone/Fax

Practice location:
  • Phone: 701-969-0416
  • Fax: 313-277-9543
Mailing address:
  • Phone: 701-969-0416
  • Fax: 313-277-9543

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number4704353139
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: