Individual
COURTNEY BROOKE WYANT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
FNP-C
Contact information
Practice address
3304 COOLEY CT, PORTAGE, MI 49024-7430
(269) 349-2266
Mailing address
6053 SAN GABRIEL APT E, KALAMAZOO, MI 49009-9686
(269) 823-3504
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
4704275200
MI
363LF0000X
Family Nurse Practitioner
4704275200
MI
Other
Enumeration date
10/27/2020
Last updated
12/01/2020
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