Provider Demographics
NPI:1053784199
Name:MANICA, BRIANNA LYNN (NP)
Entity type:Individual
Prefix:
First Name:BRIANNA
Middle Name:LYNN
Last Name:MANICA
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:BRIANNA
Other - Middle Name:LYNN
Other - Last Name:ROSENBAUM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:44201 DEQUINDRE RD., STE. 400 TROY BEAUMONT HOSPITAL
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:MI
Mailing Address - Zip Code:48085
Mailing Address - Country:US
Mailing Address - Phone:248-259-1305
Mailing Address - Fax:
Practice Address - Street 1:44201 DEQUINDRE RD., STE. 400 TROY BEAUMONT HOSPITAL
Practice Address - Street 2:
Practice Address - City:TROY
Practice Address - State:MI
Practice Address - Zip Code:48085
Practice Address - Country:US
Practice Address - Phone:248-259-1305
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-11-12
Last Update Date:2021-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704289716363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics