Basic Information
| Provider Information | |||||||||
| NPI: | 1720493687 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | CLARKE | ||||||||
| FirstName: | BRIANNA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 420 W 5TH AVE | ||||||||
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| City: | FLINT | ||||||||
| State: | MI | ||||||||
| PostalCode: | 485032445 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 1057 E COLDWATER RD | ||||||||
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| City: | FLINT | ||||||||
| State: | MI | ||||||||
| PostalCode: | 485051501 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8102573746 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/30/2014 | ||||||||
| LastUpdateDate: | 07/05/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 07/05/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 246Z00000X | N | Technologists, Technicians & Other Technical Service Providers | Specialist/Technologist, Other | 171M00000X | Y | Other Service Providers | Case Manager/Care Coordinator |
No ID Information.