Healthcare Provider Details

I. General information

NPI: 1639427016
Provider Name (Legal Business Name): EMILY JOAN BRYAN CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/16/2012
Last Update Date: 08/16/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

220 GREENE PLZ
WAYNESBURG PA
15370
US

IV. Provider business mailing address

220 GREENE PLZ
WAYNESBURG PA
15370-8144
US

V. Phone/Fax

Practice location:
  • Phone: 724-627-8582
  • Fax: 724-627-7756
Mailing address:
  • Phone: 724-627-8582
  • Fax: 724-627-7756

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberSP012182
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: