Healthcare Provider Details

I. General information

NPI: 1043680051
Provider Name (Legal Business Name): JACQUELINE BRYAN BA, RN, MS, CHC, WHE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/02/2015
Last Update Date: 02/24/2023
Certification Date: 02/24/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

51 WENTWORTH RD
RYE NH
03870-6106
US

IV. Provider business mailing address

51 WENTWORTH RD
RYE NH
03870-6106
US

V. Phone/Fax

Practice location:
  • Phone: 603-498-2988
  • Fax:
Mailing address:
  • Phone: 603-498-2988
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code133N00000X
TaxonomyNutritionist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code133NN1002X
TaxonomyNutrition Education Nutritionist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code163WC1500X
TaxonomyCommunity Health Registered Nurse
License Number037645-21
License Number StateNH
# 4
Primary TaxonomyN
Taxonomy Code174H00000X
TaxonomyHealth Educator
License Number200573
License Number StateMA
# 5
Primary TaxonomyY
Taxonomy Code174H00000X
TaxonomyHealth Educator
License Number037645-21
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: