Provider Demographics
NPI:1598178154
Name:COX, BRYAN LAWRENCE (LVN, RN)
Entity Type:Individual
Prefix:
First Name:BRYAN
Middle Name:LAWRENCE
Last Name:COX
Suffix:
Gender:M
Credentials:LVN, RN
Other - Prefix:
Other - First Name:BRYAN
Other - Middle Name:LAWRENCE
Other - Last Name:VOTAW
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LVN, RN
Mailing Address - Street 1:PO BOX 2692
Mailing Address - Street 2:
Mailing Address - City:ORANGEVALE
Mailing Address - State:CA
Mailing Address - Zip Code:95662-7403
Mailing Address - Country:US
Mailing Address - Phone:919-850-5686
Mailing Address - Fax:
Practice Address - Street 1:3331 S PORT DR
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95826-4553
Practice Address - Country:US
Practice Address - Phone:919-850-5686
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-06-10
Last Update Date:2016-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA214668164X00000X
CA95110941163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No164X00000XNursing Service ProvidersLicensed Vocational Nurse