Provider Demographics
NPI:1134545536
Name:LIND, BRYAN ROBERT (RN)
Entity type:Individual
Prefix:MR
First Name:BRYAN
Middle Name:ROBERT
Last Name:LIND
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 1:201 CHANNING ST
Mailing Address - Street 2:
Mailing Address - City:FERNDALE
Mailing Address - State:MI
Mailing Address - Zip Code:48220-2501
Mailing Address - Country:US
Mailing Address - Phone:248-496-1664
Mailing Address - Fax:
Practice Address - Street 1:201 CHANNING ST
Practice Address - Street 2:
Practice Address - City:FERNDALE
Practice Address - State:MI
Practice Address - Zip Code:48220-2501
Practice Address - Country:US
Practice Address - Phone:248-496-1664
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-03-10
Last Update Date:2014-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704270340163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse