Provider Demographics
NPI:1881365377
Name:DO, BRIAN (FNP-C, RN, CNMT)
Entity type:Individual
Prefix:
First Name:BRIAN
Middle Name:
Last Name:DO
Suffix:
Gender:M
Credentials:FNP-C, RN, CNMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3150 HALLMARK CT STE 2
Mailing Address - Street 2:
Mailing Address - City:SAGINAW
Mailing Address - State:MI
Mailing Address - Zip Code:48603-2173
Mailing Address - Country:US
Mailing Address - Phone:989-793-4420
Mailing Address - Fax:
Practice Address - Street 1:3150 HALLMARK CT STE 2
Practice Address - Street 2:
Practice Address - City:SAGINAW
Practice Address - State:MI
Practice Address - Zip Code:48603-2173
Practice Address - Country:US
Practice Address - Phone:989-793-4420
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-23
Last Update Date:2021-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704321190363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily