Provider Demographics
NPI:1043918253
Name:BRYAN, SANDELL D
Entity Type:Individual
Prefix:MRS
First Name:SANDELL
Middle Name:D
Last Name:BRYAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:SANDELL
Other - Middle Name:D
Other - Last Name:HOUSTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1552 S ROUTE 59
Mailing Address - Street 2:
Mailing Address - City:NAPERVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60564-5941
Mailing Address - Country:US
Mailing Address - Phone:800-341-0227
Mailing Address - Fax:
Practice Address - Street 1:2753 PRAIRIEVIEW LN S
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:IL
Practice Address - Zip Code:60502-2321
Practice Address - Country:US
Practice Address - Phone:630-283-1669
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-02-16
Last Update Date:2023-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL043.132060164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse