Provider Demographics
NPI:1770502577
Name:BRYAN, SANDRA LEE (CRNP)
Entity Type:Individual
Prefix:MRS
First Name:SANDRA
Middle Name:LEE
Last Name:BRYAN
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1127 PECAN AVE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:GARDENDALE
Mailing Address - State:AL
Mailing Address - Zip Code:35071-2543
Mailing Address - Country:US
Mailing Address - Phone:205-608-2055
Mailing Address - Fax:205-608-2045
Practice Address - Street 1:1127 PECAN AVE
Practice Address - Street 2:SUITE 100
Practice Address - City:GARDENDALE
Practice Address - State:AL
Practice Address - Zip Code:35071-2543
Practice Address - Country:US
Practice Address - Phone:205-608-2055
Practice Address - Fax:205-608-2045
Is Sole Proprietor?:No
Enumeration Date:2006-07-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-027836363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics