Provider Demographics
NPI:1538477005
Name:FACIONE, BRYAN ANGELO (ACNP)
Entity Type:Individual
Prefix:MR
First Name:BRYAN
Middle Name:ANGELO
Last Name:FACIONE
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Gender:M
Credentials:ACNP
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Mailing Address - Street 1:2215 FULLER RD
Mailing Address - Street 2:ROUTING NUMBER: 112; ROOM A132-1
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48105-2303
Mailing Address - Country:US
Mailing Address - Phone:734-845-5349
Mailing Address - Fax:734-845-3262
Practice Address - Street 1:2215 FULLER RD
Practice Address - Street 2:ROUTING NUMBER: 112; ROOM A132-1
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48105-2303
Practice Address - Country:US
Practice Address - Phone:734-845-5349
Practice Address - Fax:734-845-3262
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-18
Last Update Date:2010-09-18
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Provider Licenses
StateLicense IDTaxonomies
MI4704227361363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner