Provider Demographics
NPI:1194207837
Name:BRYAN, MARY MONICA (FNP)
Entity Type:Individual
Prefix:MS
First Name:MARY
Middle Name:MONICA
Last Name:BRYAN
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:MS
Other - First Name:MARY
Other - Middle Name:MONICA
Other - Last Name:MARTINEZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FNP
Mailing Address - Street 1:441 HEYMANN BLVD
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70503-2611
Mailing Address - Country:US
Mailing Address - Phone:337-289-8429
Mailing Address - Fax:337-289-8431
Practice Address - Street 1:441 HEYMANN BLVD
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70503-2611
Practice Address - Country:US
Practice Address - Phone:337-289-8429
Practice Address - Fax:337-289-8431
Is Sole Proprietor?:No
Enumeration Date:2018-08-29
Last Update Date:2019-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAAP09714363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty