Provider Demographics
NPI:1306181409
Name:CUPP, BRYAN M JR (RN)
Entity Type:Individual
Prefix:MR
First Name:BRYAN
Middle Name:M
Last Name:CUPP
Suffix:JR
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 1:121 FAIRWAY PL NW
Mailing Address - Street 2:
Mailing Address - City:WARREN
Mailing Address - State:OH
Mailing Address - Zip Code:44483-1753
Mailing Address - Country:US
Mailing Address - Phone:330-984-5950
Mailing Address - Fax:
Practice Address - Street 1:121 FAIRWAY PL NW
Practice Address - Street 2:
Practice Address - City:WARREN
Practice Address - State:OH
Practice Address - Zip Code:44483-1753
Practice Address - Country:US
Practice Address - Phone:330-984-5950
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-12-01
Last Update Date:2012-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN.341920163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse