Healthcare Provider Details

I. General information

NPI: 1376138461
Provider Name (Legal Business Name): ARLYNE EDO MICHAEL BSRN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: ARLYNE E MICHAEL BSRN

II. Dates (important events)

Enumeration Date: 03/02/2021
Last Update Date: 06/25/2021
Certification Date: 06/25/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3809 GOLD POINT ST
LAS VEGAS NV
89129-8333
US

IV. Provider business mailing address

72 CHERRY DRIVE
TROY MI
48083
US

V. Phone/Fax

Practice location:
  • Phone: 586-524-8010
  • Fax: 702-442-3813
Mailing address:
  • Phone: 586-524-8010
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WC1500X
TaxonomyCommunity Health Registered Nurse
License Number4704132973
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code163WH1000X
TaxonomyHospice Registered Nurse
License Number4704132973
License Number StateMI
# 3
Primary TaxonomyY
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License Number4704132973
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: