Provider Demographics
NPI:1659994317
Name:WESTRA, BRYNIA MARIE (PA-C)
Entity Type:Individual
Prefix:
First Name:BRYNIA
Middle Name:MARIE
Last Name:WESTRA
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:50 UNION ST
Mailing Address - Street 2:
Mailing Address - City:ELLSWORTH
Mailing Address - State:ME
Mailing Address - Zip Code:04605-1534
Mailing Address - Country:US
Mailing Address - Phone:207-664-5642
Mailing Address - Fax:
Practice Address - Street 1:50 UNION ST STE 2300
Practice Address - Street 2:
Practice Address - City:ELLSWORTH
Practice Address - State:ME
Practice Address - Zip Code:04605-1534
Practice Address - Country:US
Practice Address - Phone:207-664-5642
Practice Address - Fax:207-664-5664
Is Sole Proprietor?:Yes
Enumeration Date:2020-05-28
Last Update Date:2020-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEPA2073363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant