Provider Demographics
NPI:1932506268
Name:STURDIVANT-BRYANT, INZA
Entity Type:Individual
Prefix:
First Name:INZA
Middle Name:
Last Name:STURDIVANT-BRYANT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6770 MERRIMAN RD
Mailing Address - Street 2:
Mailing Address - City:ROMULUS
Mailing Address - State:MI
Mailing Address - Zip Code:48174-1948
Mailing Address - Country:US
Mailing Address - Phone:734-834-7870
Mailing Address - Fax:
Practice Address - Street 1:6770 MERRIMAN RD
Practice Address - Street 2:
Practice Address - City:ROMULUS
Practice Address - State:MI
Practice Address - Zip Code:48174-1948
Practice Address - Country:US
Practice Address - Phone:734-834-7870
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-12-02
Last Update Date:2014-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI247200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Other