Basic Information
Provider Information
NPI: 1770994329
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: BRYCE
FirstName: BELINDA
MiddleName: PAULINE
NamePrefix:  
NameSuffix:  
Credential: MSN, RN, FNP-BC
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: PO BOX 779
Address2:  
City: TAWAS CITY
State: MI
PostalCode: 487640779
CountryCode: US
TelephoneNumber: 9896241500
FaxNumber: 9896241506
Practice Location
Address1: 9900 BIRCH RUN RD
Address2:  
City: BIRCH RUN
State: MI
PostalCode: 48415
CountryCode: US
TelephoneNumber: 9896241500
FaxNumber: 9896241506
Other Information
ProviderEnumerationDate: 05/16/2014
LastUpdateDate: 04/06/2021
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 04/06/2021

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
363LF0000X4704272854MIY Physician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily

No ID Information.


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