Provider Demographics
NPI:1386199941
Name:MEYER, BRIANNA
Entity Type:Individual
Prefix:
First Name:BRIANNA
Middle Name:
Last Name:MEYER
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 1:4420 SWISS STONE LN E
Mailing Address - Street 2:APT C
Mailing Address - City:YPSILANTI
Mailing Address - State:MI
Mailing Address - Zip Code:48197-4914
Mailing Address - Country:US
Mailing Address - Phone:702-374-9976
Mailing Address - Fax:
Practice Address - Street 1:4420 SWISS STONE LN E
Practice Address - Street 2:APT C
Practice Address - City:YPSILANTI
Practice Address - State:MI
Practice Address - Zip Code:48197-4914
Practice Address - Country:US
Practice Address - Phone:702-374-9976
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-08-23
Last Update Date:2016-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIM600098585239247200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Other