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General NPI Number Information
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NPI Number | 1982489639
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Entity Type | Individual
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Provider Name | IMANI V BRYAN NP
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Gender | Female
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Dates
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Enumeration Date | 08/30/2023
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Last Update Date | 01/13/2025
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Provider Practice Location Address
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Address Line | 1718 BELMONT AVE STE D
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City | WINDSOR MILL
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State | MD
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Zip | 21244-2552
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Country | US
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Telephone | 617-943-0892
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Fax |
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Provider Business Mailing Address
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Address Line | 833 CHAUNCEY AVE
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City | BALTIMORE
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State | MD
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Zip | 21217-4652
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Country | US
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Telephone | 617-943-0892
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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 | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | R237854
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License Number State | MD
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