Individual
BRETT ALAN MCMAHON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
FNP-BC
Contact information
Practice address
6071 W OUTER DR, DETROIT, MI 48235-2624
(313) 966-3300
Mailing address
29944 MACINTOSH LN, NEW HUDSON, MI 48165-8906
(248) 763-0911
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
4704293922
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
4704293922
NURSE PRACTITIONER CERTIFICATION
MI
Enumeration date
12/20/2019
Last updated
05/11/2020
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