Provider Demographics
NPI:1275116808
Name:PERSONS, BRONTE M
Entity type:Individual
Prefix:
First Name:BRONTE
Middle Name:M
Last Name:PERSONS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5923 W MICHIGAN AVE UNIT C1
Mailing Address - Street 2:
Mailing Address - City:SAGINAW
Mailing Address - State:MI
Mailing Address - Zip Code:48638-5924
Mailing Address - Country:US
Mailing Address - Phone:231-313-3305
Mailing Address - Fax:
Practice Address - Street 1:5923 W MICHIGAN AVE UNIT C1
Practice Address - Street 2:
Practice Address - City:SAGINAW
Practice Address - State:MI
Practice Address - Zip Code:48638-5924
Practice Address - Country:US
Practice Address - Phone:231-313-3305
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-05-02
Last Update Date:2024-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
MI4704326846367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program