Provider Demographics
NPI:1265509459
Name:BRYANT, LINDA FAYE (RN)
Entity Type:Individual
Prefix:MS
First Name:LINDA
Middle Name:FAYE
Last Name:BRYANT
Suffix:
Gender:F
Credentials:RN
Other - Prefix:MRS
Other - First Name:LINDA
Other - Middle Name:FAYE
Other - Last Name:BRYANT
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:3769 ARCADIA LN
Mailing Address - Street 2:
Mailing Address - City:AMELIA
Mailing Address - State:OH
Mailing Address - Zip Code:45102-1201
Mailing Address - Country:US
Mailing Address - Phone:513-753-1859
Mailing Address - Fax:513-753-3098
Practice Address - Street 1:3769 ARCADIA LN
Practice Address - Street 2:
Practice Address - City:AMELIA
Practice Address - State:OH
Practice Address - Zip Code:45102-1201
Practice Address - Country:US
Practice Address - Phone:513-753-1859
Practice Address - Fax:513-753-3098
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-30
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN264206163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2430122Medicaid