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General NPI Number Information
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NPI Number | 1942538889
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Entity Type | Individual
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Provider Name | LORETTA PAULETTE BRYANT LPN
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Gender | Female
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Dates
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Enumeration Date | 12/04/2009
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Last Update Date | 12/04/2009
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Provider Practice Location Address
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Address Line | 4915 US HIGHWAY 17 LOT B 27
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City | RICHMOND HILL
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State | GA
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Zip | 31324-8808
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Country | US
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Telephone | 912-713-5151
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 2845
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City | RICHMOND HILL
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State | GA
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Zip | 31324-2845
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Country | US
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Telephone | 912-713-5151
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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 | 164W00000X
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Taxonomy Name | Licensed Practical Nurse
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License Number | LPN063099
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License Number State | GA
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Taxonomy #2
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Taxonomy Code | 164W00000X
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Taxonomy Name | Licensed Practical Nurse
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License Number | 013425-22
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License Number State | NH
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