Provider Demographics
NPI:1508815853
Name:BRYAN, NANCY JEAN (RN, CFNP)
Entity Type:Individual
Prefix:MRS
First Name:NANCY
Middle Name:JEAN
Last Name:BRYAN
Suffix:
Gender:F
Credentials:RN, CFNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6414 RIVERVIEW LN.
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75248
Mailing Address - Country:US
Mailing Address - Phone:214-733-0631
Mailing Address - Fax:214-250-2903
Practice Address - Street 1:6211 BISHOP BLVD.
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75275-0001
Practice Address - Country:US
Practice Address - Phone:214-768-2141
Practice Address - Fax:214-768-2151
Is Sole Proprietor?:No
Enumeration Date:2006-05-06
Last Update Date:2009-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX459528363LF0000X
TX458529363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8K6049Medicare UPIN