Healthcare Provider Details

I. General information

NPI: 1154870087
Provider Name (Legal Business Name): BRYAN COLE HUNTER NP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/04/2016
Last Update Date: 01/07/2021
Certification Date: 01/07/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

601 W SAVIDGE ST
SPRING LAKE MI
49456-1620
US

IV. Provider business mailing address

PO BOX 1848
MUSKEGON MI
49443-1848
US

V. Phone/Fax

Practice location:
  • Phone: 231-672-3100
  • Fax: 231-672-3102
Mailing address:
  • Phone: 231-672-2120
  • Fax: 313-432-7758

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number4704302038
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: