Provider Demographics
NPI: | 1821525544 |
---|---|
Name: | BRIGHT, ELIZABETH J (CNP) |
Entity Type: | Individual |
Prefix: | |
First Name: | ELIZABETH |
Middle Name: | J |
Last Name: | BRIGHT |
Suffix: | |
Gender: | F |
Credentials: | CNP |
Other - Prefix: | |
Other - First Name: | |
Other - Middle Name: | |
Other - Last Name: | |
Other - Suffix: | |
Other - Last Name Type: | |
Other - Credentials: | |
Mailing Address - Street 1: | 235 WEALTHY ST SE |
Mailing Address - Street 2: | |
Mailing Address - City: | GRAND RAPIDS |
Mailing Address - State: | MI |
Mailing Address - Zip Code: | 49503-5247 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 616-840-8000 |
Mailing Address - Fax: | |
Practice Address - Street 1: | 235 WEALTHY ST SE |
Practice Address - Street 2: | |
Practice Address - City: | GRAND RAPIDS |
Practice Address - State: | MI |
Practice Address - Zip Code: | 49503-5247 |
Practice Address - Country: | US |
Practice Address - Phone: | 616-840-8000 |
Practice Address - Fax: | |
Is Sole Proprietor?: | No |
Enumeration Date: | 2017-05-11 |
Last Update Date: | 2024-03-06 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
MI | 4704387764 | 363LG0600X, 363LG0600X |
OH | APRN.CNP.021466 | 363LA2100X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 363LA2100X | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Acute Care |
Yes | 363LG0600X | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Gerontology |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
OH | 0239248 | Medicaid |