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General NPI Number Information
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NPI Number | 1891482212
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Entity Type | Individual
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Provider Name | JODIE ANN BRIGHAM
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Gender | Female
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Dates
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Enumeration Date | 04/18/2023
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Last Update Date | 04/18/2023
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Provider Practice Location Address
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Address Line | 1380 E MAIN ST
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City | EDMORE
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State | MI
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Zip | 48829-8413
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Country | US
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Telephone | 989-560-9733
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Fax |
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Provider Business Mailing Address
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Address Line | 11590 LAKESHORE DR
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City | LAKEVIEW
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State | MI
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Zip | 48850-9708
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Country | US
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Telephone | 989-560-9733
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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 | 311ZA0620X
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Taxonomy Name | Adult Care Home Facility
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License Number | AM590407641
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License Number State | MI
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