Provider Demographics
NPI:1396393476
Name:BRYAN, NATTOYA (LPN,EMT-B)
Entity Type:Individual
Prefix:MS
First Name:NATTOYA
Middle Name:
Last Name:BRYAN
Suffix:
Gender:F
Credentials:LPN,EMT-B
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11 NORMAN DR
Mailing Address - Street 2:
Mailing Address - City:BLOOMFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06002-2716
Mailing Address - Country:US
Mailing Address - Phone:860-840-0353
Mailing Address - Fax:
Practice Address - Street 1:11 NORMAN DR
Practice Address - Street 2:
Practice Address - City:BLOOMFIELD
Practice Address - State:CT
Practice Address - Zip Code:06002-2716
Practice Address - Country:US
Practice Address - Phone:860-840-0353
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-31
Last Update Date:2019-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CTHCA.0001306374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide