Individual
BREANNA JOY SMITH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
200 JEFFERSON AVE SE, GRAND RAPIDS, MI 49503-4502
(616) 685-6789
(616) 685-3064
Mailing address
PO BOX 5329, SAGINAW, MI 48603-0329
(616) 364-6700
(989) 401-4245
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
5601005567
MI
Other
Enumeration date
05/20/2009
Last updated
09/11/2019
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