Provider Demographics
NPI:1245249648
Name:BRITTON, BRANDI LYNN (PA)
Entity type:Individual
Prefix:
First Name:BRANDI
Middle Name:LYNN
Last Name:BRITTON
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3409 LUDINGTON ST
Mailing Address - Street 2:SUITE 100
Mailing Address - City:ESCANABA
Mailing Address - State:MI
Mailing Address - Zip Code:49829-4212
Mailing Address - Country:US
Mailing Address - Phone:906-786-5707
Mailing Address - Fax:906-789-4406
Practice Address - Street 1:3409 LUDINGTON ST
Practice Address - Street 2:SUITE 100
Practice Address - City:ESCANABA
Practice Address - State:MI
Practice Address - Zip Code:49829-4212
Practice Address - Country:US
Practice Address - Phone:906-786-5707
Practice Address - Fax:906-789-4406
Is Sole Proprietor?:No
Enumeration Date:2006-08-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5601004288363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIP00145903OtherRR MEDICARE GROUP#CC2139
MIP00145903OtherRR MEDICARE GROUP#CC2139
MI0N081270002Medicare ID - Type Unspecified