Provider Demographics
NPI:1477744464
Name:BRYAN, MIRIAM
Entity Type:Individual
Prefix:MRS
First Name:MIRIAM
Middle Name:
Last Name:BRYAN
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 1:5358 W 250N
Mailing Address - Street 2:
Mailing Address - City:JASPER
Mailing Address - State:IN
Mailing Address - Zip Code:47546-8355
Mailing Address - Country:US
Mailing Address - Phone:812-482-6438
Mailing Address - Fax:
Practice Address - Street 1:5358 W 250N
Practice Address - Street 2:
Practice Address - City:JASPER
Practice Address - State:IN
Practice Address - Zip Code:47546-8355
Practice Address - Country:US
Practice Address - Phone:812-482-6438
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-06
Last Update Date:2007-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist