Provider Demographics
NPI:1164286423
Name:CRIST, BRYAN (RN)
Entity Type:Individual
Prefix:
First Name:BRYAN
Middle Name:
Last Name:CRIST
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5917 OTTAWA DR
Mailing Address - Street 2:
Mailing Address - City:CHEYENNE
Mailing Address - State:WY
Mailing Address - Zip Code:82001-6162
Mailing Address - Country:US
Mailing Address - Phone:307-631-0976
Mailing Address - Fax:
Practice Address - Street 1:2701 MADISON SQUARE DR
Practice Address - Street 2:
Practice Address - City:LOVELAND
Practice Address - State:CO
Practice Address - Zip Code:80538-3386
Practice Address - Country:US
Practice Address - Phone:970-820-6660
Practice Address - Fax:970-820-1099
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-07
Last Update Date:2024-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY45702163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse