Provider Demographics
NPI:1558373480
Name:BRYANT, ELLEN D
Entity Type:Individual
Prefix:
First Name:ELLEN
Middle Name:D
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 1:1001 MEADOW VIEW CIR
Mailing Address - Street 2:
Mailing Address - City:COLLEGEVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:19426-3351
Mailing Address - Country:US
Mailing Address - Phone:610-630-1330
Mailing Address - Fax:484-674-1023
Practice Address - Street 1:1001 MEADOW VIEW CIR
Practice Address - Street 2:
Practice Address - City:COLLEGEVILLE
Practice Address - State:PA
Practice Address - Zip Code:19426-3351
Practice Address - Country:US
Practice Address - Phone:610-630-1330
Practice Address - Fax:484-674-1023
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA02690501251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health