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General NPI Number Information
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NPI Number | 1396225363
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Entity Type | Individual
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Provider Name | MRS. STEPHANIE ANN BRYANT
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Gender | Female
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Dates
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Enumeration Date | 08/18/2018
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Last Update Date | 08/18/2018
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Provider Practice Location Address
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Address Line | 2200 S MAIN ST
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City | LOMBARD
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State | IL
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Zip | 60148-5334
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Country | US
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Telephone | 630-613-8985
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Fax | 630-519-3543
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Provider Business Mailing Address
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Address Line | 302 ADDISON CT
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City | OSWEGO
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State | IL
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Zip | 60543-3303
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Country | US
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Telephone | 757-309-2210
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 253Z00000X
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Taxonomy Name | In Home Supportive Care Agency
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License Number |
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License Number State |
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