Provider Demographics
NPI:1548681539
Name:BRYCE, ALEXANDRIA NICOLE (RN, BSN, CCP)
Entity type:Individual
Prefix:MISS
First Name:ALEXANDRIA
Middle Name:NICOLE
Last Name:BRYCE
Suffix:
Gender:F
Credentials:RN, BSN, CCP
Other - Prefix:MISS
Other - First Name:LEXIE
Other - Middle Name:
Other - Last Name:BRYCE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RN, BSN, CCP
Mailing Address - Street 1:100 CHERRY ST SE
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49503-4526
Mailing Address - Country:US
Mailing Address - Phone:616-776-2297
Mailing Address - Fax:616-301-7557
Practice Address - Street 1:100 CHERRY ST SE
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49503-4526
Practice Address - Country:US
Practice Address - Phone:616-776-2297
Practice Address - Fax:616-301-7557
Is Sole Proprietor?:Yes
Enumeration Date:2013-12-18
Last Update Date:2013-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704293618163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse