MEDICARE: ALICE BRYANT STNA

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	376K00000X	Nurse's Aide	400020130901	OH

General Provider Information

NPI Number	:	1730594276
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALICE BRYANT STNA

Provider Business Mailing Address
First Line	:	1350 GIEL AVE
Second Line	:
City	:	LAKEWOOD
State	:	OH
Zip	:	44107-2732
Country	:	US
Telephone Number	:	216-644-4355
Fax Number	:

Provider Business Practice Location Address
First Line	:	1350 GIEL AVE
Second Line	:
City	:	LAKEWOOD
State	:	OH
Zip	:	44107-2732
Country	:	US
Telephone Number	:	216-644-4355
Fax Number	:

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

Provider Enumeration Date	:	06/24/2014
Last Update Date	:	06/24/2014

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Directions to “ ALICE BRYANT STNA” Practice Location

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