Healthcare Provider Details

I. General information

NPI: 1184676066
Provider Name (Legal Business Name): BRIAN HOWARD ARNP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/17/2006
Last Update Date: 03/31/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

205 N EAST AVE
JACKSON MI
49201-1753
US

IV. Provider business mailing address

2425 S 171ST ST
OMAHA NE
68130-2393
US

V. Phone/Fax

Practice location:
  • Phone: 517-788-4800
  • Fax:
Mailing address:
  • Phone: 800-856-6385
  • Fax: 877-553-0660

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number4225-P
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: