Provider Demographics
NPI:1639703473
Name:LEDL, BRIAN (DNP, APRN, AGPCNP-C)
Entity Type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:
Last Name:LEDL
Suffix:
Gender:M
Credentials:DNP, APRN, AGPCNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5200 ANTHONY WAYNE DR
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48202-3945
Mailing Address - Country:US
Mailing Address - Phone:313-577-5041
Mailing Address - Fax:
Practice Address - Street 1:5285 ANTHONY WAYNE DR
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48202-3947
Practice Address - Country:US
Practice Address - Phone:313-577-5041
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-03-02
Last Update Date:2021-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704276874163WC1400X, 163WG0000X, 363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No163WC1400XNursing Service ProvidersRegistered NurseCollege Health
No163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice