Healthcare Provider Details

I. General information

NPI: 1821627100
Provider Name (Legal Business Name): BRENDAN HARMS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/07/2020
Last Update Date: 04/07/2020
Certification Date: 04/07/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

53919 ATHERTON ST
NEW BALTIMORE MI
48047-5832
US

IV. Provider business mailing address

53919 ATHERTON ST
NEW BALTIMORE MI
48047-5832
US

V. Phone/Fax

Practice location:
  • Phone: 248-420-1095
  • Fax:
Mailing address:
  • Phone: 248-420-1095
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code133NN1002X
TaxonomyNutrition Education Nutritionist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: