Provider Demographics
NPI:1457754533
Name:PEARSON, REINA BROJAN (MS,FNP-C)
Entity Type:Individual
Prefix:
First Name:REINA
Middle Name:BROJAN
Last Name:PEARSON
Suffix:
Gender:F
Credentials:MS,FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11086 OAK LN APT 8306
Mailing Address - Street 2:
Mailing Address - City:BELLEVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:48111-4335
Mailing Address - Country:US
Mailing Address - Phone:734-233-4953
Mailing Address - Fax:
Practice Address - Street 1:6001 W OUTER DR
Practice Address - Street 2:SUITE 114
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48235-2614
Practice Address - Country:US
Practice Address - Phone:313-966-9095
Practice Address - Fax:313-966-9294
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-02
Last Update Date:2015-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704259694363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily