=====================================================
General NPI Number Information
=====================================================
NPI Number | 1497565824
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | BRIGHT PATH BEHAVIORAL HEALTH
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/08/2025
-----------------------------------------------------
Last Update Date | 01/08/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 903 BOYCE DR
-----------------------------------------------------
City | RHINELANDER
-----------------------------------------------------
State | WI
-----------------------------------------------------
Zip | 54501-3836
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 715-493-0939
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 7280 OAK DR
-----------------------------------------------------
City | RHINELANDER
-----------------------------------------------------
State | WI
-----------------------------------------------------
Zip | 54501-9120
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 715-550-0546
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PSYCHIATRIC NP
-----------------------------------------------------
Name | MARLEEN A BRYAN
-----------------------------------------------------
Credential | NURSE PRACTITIONER
-----------------------------------------------------
Telephone | 715-550-0546
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LP0808X
-----------------------------------------------------
Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------