Healthcare Provider Details

I. General information

NPI: 1619894649
Provider Name (Legal Business Name): ANNISSA ELAINE BRADY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/01/2026
Last Update Date: 08/07/2026
Certification Date: 08/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

824 N WISNER ST
JACKSON MI
49202-3141
US

IV. Provider business mailing address

824 N WISNER ST
JACKSON MI
49202-3141
US

V. Phone/Fax

Practice location:
  • Phone: 517-782-6422
  • Fax: 517-782-2057
Mailing address:
  • Phone: 517-782-6422
  • Fax: 517-782-2057

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License Number3502005148
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: