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General NPI Number Information
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NPI Number | 1013043256
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Entity Type | Organization
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Legal Business Name | BRIGHT CONNECTION INFUSION CENTER
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Dates
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Enumeration Date | 02/24/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 418 E GRAND BLVD
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City | DETROIT
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State | MI
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Zip | 48207-3619
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Country | US
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Telephone | 313-267-0603
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Fax |
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Provider Business Mailing Address
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Address Line | 400 E GRAND BLVD
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City | DETROIT
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State | MI
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Zip | 48207-3619
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Country | US
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Telephone | 313-778-5683
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Fax |
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Authorized Official
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Title or Position | REGISTERED NURSE
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Name | MRS. DONNA NEALOUS BROWN
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Credential |
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Telephone | 313-778-5683
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 163WI0500X
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Taxonomy Name | Infusion Therapy Registered Nurse
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License Number | 4704229459
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License Number State | MI
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