Individual
MR. BRYAN SHAWN PARKS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
C.R.N.A.
Contact information
Practice address
408 HAZEN ST, PAW PAW, MI 49079-1019
(269) 657-3141
Mailing address
10390 S 2ND ST, SCHOOLCRAFT, MI 49087-9444
(269) 668-4787
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
4704202241
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
430H060120
BCBSM
MI
Enumeration date
04/10/2007
Last updated
06/04/2010
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