Provider Demographics
NPI:1558146985
Name:BRYANT, YASHEEN NILSA
Entity Type:Individual
Prefix:
First Name:YASHEEN
Middle Name:NILSA
Last Name:BRYANT
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 1:155 WILLOWBROOK BLVD
Mailing Address - Street 2:
Mailing Address - City:WAYNE
Mailing Address - State:NJ
Mailing Address - Zip Code:07470-7032
Mailing Address - Country:US
Mailing Address - Phone:609-533-0986
Mailing Address - Fax:
Practice Address - Street 1:61 VIOLET ST
Practice Address - Street 2:
Practice Address - City:TRENTON
Practice Address - State:NJ
Practice Address - Zip Code:08618-5914
Practice Address - Country:US
Practice Address - Phone:609-533-0986
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-24
Last Update Date:2023-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NP07763400164W00000X
374J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula
No164W00000XNursing Service ProvidersLicensed Practical Nurse