Healthcare Provider Details

I. General information

NPI: 1427346857
Provider Name (Legal Business Name): CANDY S BRYANT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/19/2011
Last Update Date: 02/23/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

720 WOOD ST
EUREKA CA
95501-4413
US

IV. Provider business mailing address

720 WOOD ST
EUREKA CA
95501-4413
US

V. Phone/Fax

Practice location:
  • Phone: 707-268-2990
  • Fax: 707-444-9522
Mailing address:
  • Phone: 707-441-4614
  • Fax: 707-444-9255

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: