Provider Demographics
NPI:1558779090
Name:BRYAN, RANCE (ACNPC-AG)
Entity Type:Individual
Prefix:MR
First Name:RANCE
Middle Name:
Last Name:BRYAN
Suffix:
Gender:M
Credentials:ACNPC-AG
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3635 VISTA AVE AT GRAND BLVD
Mailing Address - Street 2:3RD FLOOR DEPT OF TRAUMA SURGERY
Mailing Address - City:ST. LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63110
Mailing Address - Country:US
Mailing Address - Phone:314-268-7777
Mailing Address - Fax:314-268-5194
Practice Address - Street 1:3635 VISTA AVE
Practice Address - Street 2:3RD FLOOR DEPT OF TRAUMA SURGERY
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63110-2539
Practice Address - Country:US
Practice Address - Phone:314-268-7777
Practice Address - Fax:314-268-5194
Is Sole Proprietor?:No
Enumeration Date:2014-07-29
Last Update Date:2014-07-29
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MO2014012216363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care