MEDICARE: NATALIE BRYAN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103K00000X	Behavior Analyst	0133001079	VA

General Provider Information

NPI Number	:	1538675848
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NATALIE BRYAN

Provider Business Mailing Address
First Line	:	5621 TIDEWATER DR
Second Line	:
City	:	NORFOLK
State	:	VA
Zip	:	23509-1497
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	5621 TIDEWATER DR
Second Line	:
City	:	NORFOLK
State	:	VA
Zip	:	23509-1497
Country	:	US
Telephone Number	:	757-635-4244
Fax Number	:	757-271-0629

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/21/2017
Last Update Date	:	11/17/2023

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