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Individual

JENNIFER BRYCE

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
PA-C

Contact information

Practice address
1 WILLIAM CARLS DR, COMMERCE TOWNSHIP, MI 48382-2201
(248) 937-4764
(248) 937-4729
Mailing address
42557 WOODWARD AVE, STE 130, BLOOMFIELD HILLS, MI 48304-5206
(248) 322-3088
(248) 322-4175

Taxonomy

Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
5601002383
MI

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
1265551097
MI
01
500H274490
BCBSM GROUP PIN MHP
MI
01
DS0605
RAIL ROAD MEDICARE GROUP PIN MHP
MI
01
MI4989
MEDICARE GROUP PTAN MHP
MI
01
MI4989416
MEDICARE PTAN MHP
MI
Enumeration date
03/29/2007
Last updated
06/30/2014
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