| Doctor Name: | BRIAN VESNAUGH |
| NPI Number: | 1477896926 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | NP-C |
| License Number: | 4704207694 |
| Business Practice Address: | 8033 E 10 Mile Rd Suite 101 Center Line, MI - 480151427 |
| Business Phone Number: | 5869772900 |
| Business Fax Number: | 5869772992 |
| Mailing Address: | 8033 E 10 Mile Rd, Suite 101 CENTER LINE |
| State: | MI |
| Postal Code: | 480151427 |
| Phone Number: | 5869772900 |
| Fax Number: | 5869772992 |
| NPI Enumeration Date: | 04/03/2013 |
| NPI Last Update Date: | 03/17/2014 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363LF0000X |
| License Number: | 4704207694 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | MI |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Nurse Practitioner |
| Taxonomy Specialization: | Family |
| Taxonomy Definition: | |