Provider Demographics
NPI:1104705045
Name:BRYANT, TAMEKA DONYELL (CNA)
Entity type:Individual
Prefix:
First Name:TAMEKA
Middle Name:DONYELL
Last Name:BRYANT
Suffix:
Gender:F
Credentials:CNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11863 WILSHIRE DR
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48213-1618
Mailing Address - Country:US
Mailing Address - Phone:313-264-2739
Mailing Address - Fax:
Practice Address - Street 1:15700 W 10 MILE RD STE 212
Practice Address - Street 2:
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48075-2143
Practice Address - Country:US
Practice Address - Phone:248-982-1046
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-08-27
Last Update Date:2025-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI230006095371001376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI230006095371001OtherBCHS NURSE AIDE