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NPI Code Detail

MEDICARE: NICOLE RENEE BRISSE

MEDICARE: NICOLE RENEE BRISSE
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1106S00000XBehavior Technician171M00000XMI

General Provider Information

NPI Number : 1437853702
Entity Type Code : Individual
Provider Name (Legal Business Name) : NICOLE RENEE BRISSE
Provider Business Mailing Address
First Line : 6540 PARK VALLEY DR
Second Line :
City : CLARKSTON
State : MI
Zip : 48348-4552
Country : US
Telephone Number : 248-303-3030
Fax Number :
Provider Business Practice Location Address
First Line : 505 E MAPLE RD
Second Line :
City : TROY
State : MI
Zip : 48083-2806
Country : US
Telephone Number : 248-918-5600
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/29/2023
Last Update Date : 05/15/2023

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Directions to “ NICOLE RENEE BRISSE ” Practice Location

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These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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