Healthcare Provider Details

I. General information

NPI: 1245919851
Provider Name (Legal Business Name): BRITTANY LEE BORDEAUX
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: BRITTANY LEE ERVIN

II. Dates (important events)

Enumeration Date: 07/12/2023
Last Update Date: 07/12/2023
Certification Date: 07/12/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1145 WESLEY AVE
MUSKEGON MI
49442-2100
US

IV. Provider business mailing address

1145 WESLEY AVE
MUSKEGON MI
49442-2100
US

V. Phone/Fax

Practice location:
  • Phone: 231-260-1931
  • Fax:
Mailing address:
  • Phone: 231-260-1931
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374700000X
TaxonomyTechnician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: