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General NPI Number Information
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NPI Number | 1639767502
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Entity Type | Individual
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Provider Name | BRIANNA NICOLE BRYAN PA
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Gender | Female
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Dates
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Enumeration Date | 01/06/2021
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Last Update Date | 09/28/2021
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Provider Practice Location Address
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Address Line | 4350 US 421 S
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City | LILLINGTON
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State | NC
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Zip | 27546-6760
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Country | US
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Telephone | 910-893-1210
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Fax |
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Provider Business Mailing Address
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Address Line | 4905 HALBERD CT
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City | RALEIGH
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State | NC
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Zip | 27613-6088
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Country | US
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Telephone |
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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 | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 0010-11523
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License Number State | NC
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