Healthcare Provider Details

I. General information

NPI: 1417981713
Provider Name (Legal Business Name): JENNIFER L BRYAN FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/10/2006
Last Update Date: 10/26/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

310 N 9TH ST
BISMARCK ND
58501-4515
US

IV. Provider business mailing address

310 N 9TH ST
BISMARCK ND
58501-4515
US

V. Phone/Fax

Practice location:
  • Phone: 701-530-8744
  • Fax: 701-530-8772
Mailing address:
  • Phone: 701-530-7000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberR32204
License Number StateND

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: