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General NPI Number Information
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NPI Number | 1760044499
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Entity Type | Individual
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Provider Name | BETHANY BRYANT
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Gender | Female
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Dates
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Enumeration Date | 07/02/2019
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Last Update Date | 03/20/2023
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Provider Practice Location Address
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Address Line | 18610 FENKELL ST
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City | DETROIT
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State | MI
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Zip | 48223-2378
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Country | US
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Telephone | 313-723-6000
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Fax | 313-424-4058
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Provider Business Mailing Address
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Address Line | 25670 W 12 MILE RD APT 304
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City | SOUTHFIELD
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State | MI
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Zip | 48034-8014
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Country | US
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Telephone | 313-285-6418
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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 | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | 4704295004
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License Number State | MI
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Taxonomy #2
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Taxonomy Code | 363LA2100X
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Taxonomy Name | Acute Care Nurse Practitioner
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License Number | 4704295004
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License Number State | MI
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