Provider Demographics
NPI:1417981713
Name:BRYAN, JENNIFER L (FNP)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:L
Last Name:BRYAN
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:310 N 9TH ST
Mailing Address - Street 2:
Mailing Address - City:BISMARCK
Mailing Address - State:ND
Mailing Address - Zip Code:58501-4515
Mailing Address - Country:US
Mailing Address - Phone:701-530-7000
Mailing Address - Fax:
Practice Address - Street 1:310 N 9TH ST
Practice Address - Street 2:
Practice Address - City:BISMARCK
Practice Address - State:ND
Practice Address - Zip Code:58501-4515
Practice Address - Country:US
Practice Address - Phone:701-530-8744
Practice Address - Fax:701-530-8772
Is Sole Proprietor?:No
Enumeration Date:2006-07-10
Last Update Date:2017-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NDR32204363LF0000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND1452642Medicaid
ND1452642Medicaid
NDN712402Medicare PIN
NDP00362921OtherRAILROAD MEDICARE
ND1452642Medicaid
NDR32204OtherLICENSE