Healthcare Provider Details

I. General information

NPI: 1134812951
Provider Name (Legal Business Name): BRIANNA INGEBRETSON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/29/2023
Last Update Date: 08/11/2025
Certification Date: 08/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

45547 HEATHER RIDGE DR
MACOMB MI
48044-4072
US

IV. Provider business mailing address

45547 HEATHER RIDGE DR
MACOMB MI
48044-4072
US

V. Phone/Fax

Practice location:
  • Phone: 586-206-6171
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number4704330312
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: