Provider Demographics
NPI:1750463568
Name:BRYANT, NANCY S (CRNP)
Entity Type:Individual
Prefix:
First Name:NANCY
Middle Name:S
Last Name:BRYANT
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:134 OWENSVILLE ROAD
Mailing Address - Street 2:
Mailing Address - City:WEST RIVER
Mailing Address - State:MD
Mailing Address - Zip Code:20778
Mailing Address - Country:US
Mailing Address - Phone:410-867-4700
Mailing Address - Fax:410-867-8754
Practice Address - Street 1:134 OWENSVILLE ROAD
Practice Address - Street 2:
Practice Address - City:WEST RIVER
Practice Address - State:MD
Practice Address - Zip Code:20778
Practice Address - Country:US
Practice Address - Phone:410-867-4700
Practice Address - Fax:410-867-8754
Is Sole Proprietor?:No
Enumeration Date:2006-10-20
Last Update Date:2017-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR124971363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD404482700Medicaid
MD404482700Medicaid
MDS45868Medicare UPIN