MEDICARE: MRS. CHARLOTTE MARSEE BRYANT RN,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
1	163WP0808X	Psychiatric/Mental Health Registered Nurse	0001147183	VA

General Provider Information

NPI Number	:	1639115983
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. CHARLOTTE MARSEE BRYANT RN,C

Provider Business Mailing Address
First Line	:	4324 SUNSET DR
Second Line	:
City	:	PETERSBURG
State	:	VA
Zip	:	23803-6524
Country	:	US
Telephone Number	:	804-732-4590
Fax Number	:

Provider Business Practice Location Address
First Line	:	26014 COX RD
Second Line	:
City	:	PETERSBURG
State	:	VA
Zip	:	23803-6566
Country	:	US
Telephone Number	:	804-862-8040
Fax Number	:	804-862-8089

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

Provider Enumeration Date	:	06/22/2006
Last Update Date	:	07/08/2007

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