Provider Demographics
NPI:1760614721
Name:BRONSON, MEGAN M (PMHCNS)
Entity Type:Individual
Prefix:MS
First Name:MEGAN
Middle Name:M
Last Name:BRONSON
Suffix:
Gender:F
Credentials:PMHCNS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4877 MEANDERING CREEK DR NE
Mailing Address - Street 2:
Mailing Address - City:BELMONT
Mailing Address - State:MI
Mailing Address - Zip Code:49306-9662
Mailing Address - Country:US
Mailing Address - Phone:616-874-7014
Mailing Address - Fax:
Practice Address - Street 1:4877 MEANDERING CREEK DR NE
Practice Address - Street 2:
Practice Address - City:BELMONT
Practice Address - State:MI
Practice Address - Zip Code:49306-9662
Practice Address - Country:US
Practice Address - Phone:616-874-7014
Practice Address - Fax:616-874-8661
Is Sole Proprietor?:No
Enumeration Date:2009-08-10
Last Update Date:2009-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704075894364SP0809X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SP0809XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health, Adult