Healthcare Provider Details

I. General information

NPI: 1477913234
Provider Name (Legal Business Name): JANICE BRYAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/07/2016
Last Update Date: 03/07/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

281 SAWYER DR STE 300
DURANGO CO
81303-3412
US

IV. Provider business mailing address

281 SAWYER DR STE 300
DURANGO CO
81303-3412
US

V. Phone/Fax

Practice location:
  • Phone: 970-335-2081
  • Fax: 970-247-9126
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC1500X
TaxonomyCommunity Health Registered Nurse
License NumberRN0189456
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: