Provider Demographics
NPI:1073147039
Name:BRYCELAND, MARTA M (AGNP-BC)
Entity Type:Individual
Prefix:
First Name:MARTA
Middle Name:M
Last Name:BRYCELAND
Suffix:
Gender:F
Credentials:AGNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:502 LIVINGSTON CT
Mailing Address - Street 2:
Mailing Address - City:EDGEWATER
Mailing Address - State:NJ
Mailing Address - Zip Code:07020-1640
Mailing Address - Country:US
Mailing Address - Phone:201-397-8058
Mailing Address - Fax:
Practice Address - Street 1:502 LIVINGSTON CT
Practice Address - Street 2:
Practice Address - City:EDGEWATER
Practice Address - State:NJ
Practice Address - Zip Code:07020-1640
Practice Address - Country:US
Practice Address - Phone:201-397-8058
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-02-28
Last Update Date:2023-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF309564363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology