Provider Demographics
NPI:1871827626
Name:WERMERS, BRYAN MATTHEW (CPNP)
Entity Type:Individual
Prefix:
First Name:BRYAN
Middle Name:MATTHEW
Last Name:WERMERS
Suffix:
Gender:M
Credentials:CPNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7204 W 66TH ST
Mailing Address - Street 2:
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57106-8838
Mailing Address - Country:US
Mailing Address - Phone:605-988-4896
Mailing Address - Fax:
Practice Address - Street 1:1600 W 22ND STREET
Practice Address - Street 2:
Practice Address - City:SIOUX FALLS
Practice Address - State:SD
Practice Address - Zip Code:57117-5039
Practice Address - Country:US
Practice Address - Phone:605-312-1000
Practice Address - Fax:605-312-1008
Is Sole Proprietor?:No
Enumeration Date:2009-09-28
Last Update Date:2009-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SDCP000573363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics