Provider Demographics
NPI:1033186457
Name:BRYAN, JANICE K (AON)
Entity Type:Individual
Prefix:
First Name:JANICE
Middle Name:K
Last Name:BRYAN
Suffix:
Gender:F
Credentials:AON
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:780 KUENZLI ST
Mailing Address - Street 2:SUITE 202
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89502-0845
Mailing Address - Country:US
Mailing Address - Phone:775-982-4590
Mailing Address - Fax:775-982-4595
Practice Address - Street 1:10085 DOUBLE R BLVD
Practice Address - Street 2:STE 120
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89521-5860
Practice Address - Country:US
Practice Address - Phone:775-982-5000
Practice Address - Fax:775-982-8180
Is Sole Proprietor?:No
Enumeration Date:2006-03-03
Last Update Date:2009-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX252635363L00000X
NVAPN000950363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
11934129OtherCAQH
Q29327Medicare UPIN
NVBQ601ZMedicare PIN
NVV104035Medicare PIN