Provider Demographics
NPI:1619911617
Name:BOOK, BRITTNEY SUZANNE (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:BRITTNEY
Middle Name:SUZANNE
Last Name:BOOK
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:01920 HETRICK RD
Mailing Address - Street 2:
Mailing Address - City:BOYNE FALLS
Mailing Address - State:MI
Mailing Address - Zip Code:49713
Mailing Address - Country:US
Mailing Address - Phone:231-622-1410
Mailing Address - Fax:
Practice Address - Street 1:825 N CENTER AVE
Practice Address - Street 2:
Practice Address - City:GAYLORD
Practice Address - State:MI
Practice Address - Zip Code:49735-1592
Practice Address - Country:US
Practice Address - Phone:989-731-2100
Practice Address - Fax:989-731-2205
Is Sole Proprietor?:No
Enumeration Date:2006-06-16
Last Update Date:2009-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5601003256363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0M29550003Medicare PIN