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General NPI Number Information
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NPI Number | 1366103145
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Entity Type | Individual
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Provider Name | BRIELLE LORRAINE HAUPT NP
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Gender | Female
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Dates
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Enumeration Date | 01/04/2022
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Last Update Date | 01/04/2022
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Provider Practice Location Address
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Address Line | 41424 ANN ARBOR RD E
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City | PLYMOUTH
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State | MI
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Zip | 48170-8005
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Country | US
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Telephone | 734-206-7725
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Fax |
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Provider Business Mailing Address
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Address Line | 6427 GRAND CIRCLE DR
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City | BRIGHTON
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State | MI
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Zip | 48116-9419
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Country | US
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Telephone | 810-599-0748
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 4704321787
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License Number State | MI
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