Provider Demographics
NPI:1184963639
Name:MCBRATNIE, CAROL ANN (NP)
Entity type:Individual
Prefix:
First Name:CAROL
Middle Name:ANN
Last Name:MCBRATNIE
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1130 LARKMOOR BLVD
Mailing Address - Street 2:
Mailing Address - City:BERKLEY
Mailing Address - State:MI
Mailing Address - Zip Code:48072-1906
Mailing Address - Country:US
Mailing Address - Phone:248-546-5945
Mailing Address - Fax:
Practice Address - Street 1:5498 109TH AVE
Practice Address - Street 2:
Practice Address - City:PULLMAN
Practice Address - State:MI
Practice Address - Zip Code:49450-9631
Practice Address - Country:US
Practice Address - Phone:269-236-6330
Practice Address - Fax:269-236-5411
Is Sole Proprietor?:No
Enumeration Date:2013-02-04
Last Update Date:2014-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704265251363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health