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General NPI Number Information
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NPI Number | 1578961728
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Entity Type | Individual
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Provider Name | BRYAN ALLEN
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Gender | Male
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Dates
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Enumeration Date | 12/19/2014
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Last Update Date | 11/06/2025
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Provider Practice Location Address
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Address Line | 301 SOUTHBRIDGE DR
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City | JACKSONVILLE
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State | NC
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Zip | 28546-7884
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Country | US
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Telephone | 910-450-4841
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Fax |
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Provider Business Mailing Address
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Address Line | 2006 PELICAN HILL RD
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City | SAN DIEGO
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State | CA
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Zip | 92139-1151
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Country | US
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Telephone | 803-236-0332
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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 | 163WE0003X
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Taxonomy Name | Emergency Registered Nurse
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License Number | RN-112950
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License Number State | HI
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