Healthcare Provider Details

I. General information

NPI: 1639115983
Provider Name (Legal Business Name): CHARLOTTE MARSEE BRYANT RN,C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/22/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

26014 COX RD
PETERSBURG VA
23803-6566
US

IV. Provider business mailing address

4324 SUNSET DR
PETERSBURG VA
23803-6524
US

V. Phone/Fax

Practice location:
  • Phone: 804-862-8040
  • Fax: 804-862-8089
Mailing address:
  • Phone: 804-732-4590
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License Number0001147183
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: