Provider Demographics
NPI:1962210203
Name:JOHNSON, BRITTANY CHYANE
Entity type:Individual
Prefix:
First Name:BRITTANY
Middle Name:CHYANE
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:BEE
Other - Middle Name:CHYANE
Other - Last Name:JOHNSON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1047 HOLLYWOOD ST NE
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49505-3835
Mailing Address - Country:US
Mailing Address - Phone:860-866-8947
Mailing Address - Fax:
Practice Address - Street 1:1047 HOLLYWOOD ST NE
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49505-3835
Practice Address - Country:US
Practice Address - Phone:860-866-8947
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-12-19
Last Update Date:2025-08-14
Deactivation Date:2024-12-26
Deactivation Code:
Reactivation Date:2025-08-14
Provider Licenses
StateLicense IDTaxonomies
MIMIIA0059709R376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide