MEDICARE: SVEA LYNN BRYAN LVN

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	164X00000X	Licensed Vocational Nurse	201615	TX

General Provider Information

NPI Number	:	1942449178
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SVEA LYNN BRYAN LVN

Provider Business Mailing Address
First Line	:	1101 S. MAIN STREET
Second Line	:	SUITE 1500
City	:	FORT WORTH
State	:	TX
Zip	:	76104-4802
Country	:	US
Telephone Number	:	817-321-4800
Fax Number	:	817-321-4818

Provider Business Practice Location Address
First Line	:	1101 S. MAIN STREET
Second Line	:	SUITE 1500
City	:	FORT WORTH
State	:	TX
Zip	:	76104-4802
Country	:	US
Telephone Number	:	817-321-4800
Fax Number	:	817-321-4818

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

Provider Enumeration Date	:	02/11/2009
Last Update Date	:	02/11/2009

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