MEDICARE: ELLA BRYANT

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
1	163WG0000X	General Practice Registered Nurse	28182563A	IN

General Provider Information

NPI Number	:	1154990992
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ELLA BRYANT

Provider Business Mailing Address
First Line	:	871 PACER DR NW
Second Line	:
City	:	CORYDON
State	:	IN
Zip	:	47112-2145
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	871 PACER DR NW
Second Line	:
City	:	CORYDON
State	:	IN
Zip	:	47112-2145
Country	:	US
Telephone Number	:	812-738-0317
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/24/2021
Last Update Date	:	06/24/2021

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Directions to “ ELLA BRYANT ” Practice Location

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