Basic Information
| Provider Information | |||||||||
| NPI: | 1689013716 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | TOTTEN | ||||||||
| FirstName: | BRIAN | ||||||||
| MiddleName: | ROBERT | ||||||||
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| Credential: | R.N. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 470 FEDERAL ST | ||||||||
| Address2: | |||||||||
| City: | SAND LAKE | ||||||||
| State: | MI | ||||||||
| PostalCode: | 493439101 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2318460902 | ||||||||
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| Practice Location | |||||||||
| Address1: | 500 S 3RD AVE | ||||||||
| Address2: | |||||||||
| City: | BIG RAPIDS | ||||||||
| State: | MI | ||||||||
| PostalCode: | 493079501 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2317963553 | ||||||||
| FaxNumber: | 2317962409 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/21/2013 | ||||||||
| LastUpdateDate: | 06/21/2013 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163W00000X | 4704262070 | MI | Y | Nursing Service Providers | Registered Nurse |
No ID Information.