Provider Demographics
NPI:1861018640
Name:IRWIN, BRIAN GEORGE (RN)
Entity Type:Individual
Prefix:
First Name:BRIAN
Middle Name:GEORGE
Last Name:IRWIN
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7049 MISTY MOOR DR
Mailing Address - Street 2:
Mailing Address - City:GRAND BLANC
Mailing Address - State:MI
Mailing Address - Zip Code:48439-9289
Mailing Address - Country:US
Mailing Address - Phone:810-845-2505
Mailing Address - Fax:
Practice Address - Street 1:7049 MISTY MOOR DR
Practice Address - Street 2:
Practice Address - City:GRAND BLANC
Practice Address - State:MI
Practice Address - Zip Code:48439-9289
Practice Address - Country:US
Practice Address - Phone:810-845-2505
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-17
Last Update Date:2020-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704283858163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse