Provider Demographics
NPI:1548759855
Name:BRYAN, SUMMER (CRM)
Entity Type:Individual
Prefix:
First Name:SUMMER
Middle Name:
Last Name:BRYAN
Suffix:
Gender:F
Credentials:CRM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:YELLOWHAWK TRIBAL HEALTH CENTER
Mailing Address - Street 2:PO BOX 160
Mailing Address - City:PENDLETON
Mailing Address - State:OR
Mailing Address - Zip Code:97801
Mailing Address - Country:US
Mailing Address - Phone:541-966-9830
Mailing Address - Fax:541-962-0119
Practice Address - Street 1:YELLOWHAWK TRIBAL HEALTH CENTER
Practice Address - Street 2:46314 TIMINE WAY
Practice Address - City:PENDLETON
Practice Address - State:OR
Practice Address - Zip Code:97801
Practice Address - Country:US
Practice Address - Phone:541-966-9830
Practice Address - Fax:541-962-0119
Is Sole Proprietor?:No
Enumeration Date:2018-05-02
Last Update Date:2022-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR202100591RN163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse