Healthcare Provider Details

I. General information

NPI: 1558855544
Provider Name (Legal Business Name): BRYN JOELLE PAPE DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/21/2018
Last Update Date: 01/30/2024
Certification Date: 01/30/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1675 LEAHY ST STE 215A
MUSKEGON MI
49442-5542
US

IV. Provider business mailing address

1675 LEAHY ST STE 201A
MUSKEGON MI
49442-5542
US

V. Phone/Fax

Practice location:
  • Phone: 616-685-3098
  • Fax: 616-685-3095
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License Number5101027701
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: