Healthcare Provider Details

I. General information

NPI: 1134470966
Provider Name (Legal Business Name): JOSHUA MARK BRYANT R.N.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/19/2012
Last Update Date: 09/19/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

580 N. JEFFERSON ST.
UTICA OH
43080-0727
US

IV. Provider business mailing address

PO BOX 727
UTICA OH
43080-0727
US

V. Phone/Fax

Practice location:
  • Phone: 740-975-6328
  • Fax:
Mailing address:
  • Phone: 740-975-6328
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN. 383497
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: