Provider Demographics
NPI:1184206658
Name:STRONG, BREANA
Entity Type:Individual
Prefix:MRS
First Name:BREANA
Middle Name:
Last Name:STRONG
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21800 HAGGERTY RD STE 113
Mailing Address - Street 2:
Mailing Address - City:NORTHVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:48167-9051
Mailing Address - Country:US
Mailing Address - Phone:248-277-3110
Mailing Address - Fax:
Practice Address - Street 1:21800 HAGGERTY RD STE 113
Practice Address - Street 2:
Practice Address - City:NORTHVILLE
Practice Address - State:MI
Practice Address - Zip Code:48167-9051
Practice Address - Country:US
Practice Address - Phone:248-277-3110
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-04-24
Last Update Date:2023-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704318297363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
NAOtherNA