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General NPI Number Information
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NPI Number | 1346950623
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Entity Type | Individual
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Provider Name | BRANDIE MARIE MANNI PA-C
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Gender | Female
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Dates
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Enumeration Date | 11/28/2022
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Last Update Date | 11/28/2022
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Provider Practice Location Address
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Address Line | 7804 ALLEN RD
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City | ALLEN PARK
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State | MI
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Zip | 48101-1702
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Country | US
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Telephone | 313-562-1985
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Fax |
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Provider Business Mailing Address
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Address Line | 13108 WOODRIDGE CIR
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City | PLYMOUTH
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State | MI
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Zip | 48170-3891
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Country | US
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Telephone | 810-844-6056
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 5601011498
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License Number State | MI
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