Provider Demographics
NPI:1881186518
Name:BRYANT, MIRANDA Y
Entity Type:Individual
Prefix:
First Name:MIRANDA
Middle Name:Y
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 1:707 COLLEGE ST
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:NC
Mailing Address - Zip Code:28328-3503
Mailing Address - Country:US
Mailing Address - Phone:910-592-4507
Mailing Address - Fax:910-592-4494
Practice Address - Street 1:707 COLLEGE ST
Practice Address - Street 2:
Practice Address - City:CLINTON
Practice Address - State:NC
Practice Address - Zip Code:28328-3503
Practice Address - Country:US
Practice Address - Phone:910-592-4507
Practice Address - Fax:910-592-4494
Is Sole Proprietor?:No
Enumeration Date:2018-05-30
Last Update Date:2018-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist