Provider Demographics
NPI:1003143223
Name:BRYNELSON, GREGORY SUMNER PAYNE (RN)
Entity Type:Individual
Prefix:MR
First Name:GREGORY
Middle Name:SUMNER PAYNE
Last Name:BRYNELSON
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:GREG
Other - Middle Name:PAYNE
Other - Last Name:BRYNELSON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RN
Mailing Address - Street 1:555 MISSION ROCK ST UNIT 103
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94158-2150
Mailing Address - Country:US
Mailing Address - Phone:415-513-2902
Mailing Address - Fax:
Practice Address - Street 1:555 MISSION ROCK ST UNIT 103
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94158-2150
Practice Address - Country:US
Practice Address - Phone:415-513-2902
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-11-09
Last Update Date:2009-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA689286163WM0705X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WM0705XNursing Service ProvidersRegistered NurseMedical-Surgical