Individual
JACOB RUSSELL BRYDE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DNP, AGPCNP-BC
Contact information
Practice address
804 SERVICE RD STE A110, EAST LANSING, MI 48824-7015
(517) 353-2822
(517) 355-2824
Mailing address
804 SERVICE RD STE A202, EAST LANSING, MI 48824-7015
(517) 355-2822
(517) 355-2824
Taxonomy
Speciality
Code
Description
License number
State
363LG0600X
Gerontology Nurse Practitioner
Primary
4704335991
MI
Other
Enumeration date
07/20/2024
Last updated
10/15/2024
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