Provider Demographics
NPI:1356832158
Name:BRYER, SUSAN A
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:A
Last Name:BRYER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 110
Mailing Address - Street 2:
Mailing Address - City:GAMBELL
Mailing Address - State:AK
Mailing Address - Zip Code:99742-0110
Mailing Address - Country:US
Mailing Address - Phone:907-312-9954
Mailing Address - Fax:
Practice Address - Street 1:GRAVEL BLVD
Practice Address - Street 2:
Practice Address - City:GAMBELL
Practice Address - State:AK
Practice Address - Zip Code:99742
Practice Address - Country:US
Practice Address - Phone:907-985-5031
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-05-29
Last Update Date:2018-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker