Provider Demographics
NPI:1639820327
Name:BRYANT, TIAWNA MICHELLE (REGISTERED NURSE)
Entity Type:Individual
Prefix:
First Name:TIAWNA
Middle Name:MICHELLE
Last Name:BRYANT
Suffix:
Gender:F
Credentials:REGISTERED NURSE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:31008 BARRINGTON ST
Mailing Address - Street 2:
Mailing Address - City:WESTLAND
Mailing Address - State:MI
Mailing Address - Zip Code:48186-5323
Mailing Address - Country:US
Mailing Address - Phone:313-333-0223
Mailing Address - Fax:
Practice Address - Street 1:25050 OUTER DR
Practice Address - Street 2:
Practice Address - City:LINCOLN PARK
Practice Address - State:MI
Practice Address - Zip Code:48146-1297
Practice Address - Country:US
Practice Address - Phone:313-751-8404
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-13
Last Update Date:2022-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704279209163WG0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice