Provider Demographics
NPI:1588914691
Name:WEBER, BRYANNA RUTH (PA-C, RD)
Entity type:Individual
Prefix:
First Name:BRYANNA
Middle Name:RUTH
Last Name:WEBER
Suffix:
Gender:F
Credentials:PA-C, RD
Other - Prefix:
Other - First Name:BRYANNA
Other - Middle Name:RUTH
Other - Last Name:LEHMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C, RD
Mailing Address - Street 1:1005 S US HIGHWAY 27
Mailing Address - Street 2:SUITE 100
Mailing Address - City:SAINT JOHNS
Mailing Address - State:MI
Mailing Address - Zip Code:48879-2423
Mailing Address - Country:US
Mailing Address - Phone:989-224-3000
Mailing Address - Fax:989-224-1424
Practice Address - Street 1:1005 S US HIGHWAY 27
Practice Address - Street 2:SUITE 100
Practice Address - City:SAINT JOHNS
Practice Address - State:MI
Practice Address - Zip Code:48879-2423
Practice Address - Country:US
Practice Address - Phone:989-224-3000
Practice Address - Fax:989-224-1424
Is Sole Proprietor?:No
Enumeration Date:2012-09-17
Last Update Date:2024-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5601006531363A00000X
MI1020845133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No133V00000XDietary & Nutritional Service ProvidersDietitian, Registered