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General NPI Number Information
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NPI Number | 1861733693
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Entity Type | Individual
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Provider Name | SUZANNE MARIE BRYAN
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Gender | Female
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Dates
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Enumeration Date | 03/04/2013
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Last Update Date | 03/04/2013
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Provider Practice Location Address
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Address Line | 3125 NORTHERTON CT
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City | DAYTON
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State | OH
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Zip | 45414-1793
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Country | US
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Telephone | 937-264-3220
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Fax |
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Provider Business Mailing Address
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Address Line | 3125 NORTHERTON CT
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City | DAYTON
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State | OH
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Zip | 45414-1793
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Country | US
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Telephone | 937-264-3220
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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 | 2471R0002X
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Taxonomy Name | Radiation Therapy Radiologic Technologist
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License Number | 8860129
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License Number State | OH
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Taxonomy #2
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Taxonomy Code | 2471R0002X
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Taxonomy Name | Radiation Therapy Radiologic Technologist
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License Number | 4134
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License Number State | FL
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