Provider Demographics
NPI:1811236144
Name:BRYANT, LAVITA
Entity Type:Individual
Prefix:
First Name:LAVITA
Middle Name:
Last Name:BRYANT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8547 WHITE CEDAR DR
Mailing Address - Street 2:APT 320
Mailing Address - City:MIAMISBURG
Mailing Address - State:OH
Mailing Address - Zip Code:45342-5396
Mailing Address - Country:US
Mailing Address - Phone:937-718-1195
Mailing Address - Fax:
Practice Address - Street 1:8547 WHITE CEDAR DR
Practice Address - Street 2:APT 320
Practice Address - City:MIAMISBURG
Practice Address - State:OH
Practice Address - Zip Code:45342-5396
Practice Address - Country:US
Practice Address - Phone:937-718-1195
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-02-06
Last Update Date:2013-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH401251790611376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH401251790611OtherSTNA