Provider Demographics
NPI:1649576984
Name:BRYAN, MICHAEL ALFONSO (RN)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:ALFONSO
Last Name:BRYAN
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1523 NE KENNEDY LN
Mailing Address - Street 2:
Mailing Address - City:HILLSBORO
Mailing Address - State:OR
Mailing Address - Zip Code:97124-2606
Mailing Address - Country:US
Mailing Address - Phone:503-844-4830
Mailing Address - Fax:
Practice Address - Street 1:1523 NE KENNEDY LN
Practice Address - Street 2:
Practice Address - City:HILLSBORO
Practice Address - State:OR
Practice Address - Zip Code:97124-2606
Practice Address - Country:US
Practice Address - Phone:503-844-4830
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-02-03
Last Update Date:2011-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR201140052RN163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse