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NPI Code Detail

MEDICARE: JENNIFER LARA BRYANT MSN, APRN, FNP-C

MEDICARE: JENNIFER LARA BRYANT MSN, APRN, FNP-C
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363LF0000XFamily Nurse Practitioner111695NE

General Provider Information

NPI Number : 1144637000
Entity Type Code : Individual
Provider Name (Legal Business Name) : JENNIFER LARA BRYANT MSN, APRN, FNP-C
Provider Business Mailing Address
First Line : 14618 M ST
Second Line :
City : OMAHA
State : NE
Zip : 68137-1351
Country : US
Telephone Number : 308-750-7984
Fax Number :
Provider Business Practice Location Address
First Line : 14460 W MAPLE RD
Second Line :
City : OMAHA
State : NE
Zip : 68116-5163
Country : US
Telephone Number : 866-388-2727
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/11/2014
Last Update Date : 04/12/2016

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