Provider Demographics
NPI:1922647221
Name:BRYANT, BRIAN ERIC (RN)
Entity Type:Individual
Prefix:
First Name:BRIAN
Middle Name:ERIC
Last Name:BRYANT
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9874 W SLEEPY HOLLOW LN
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83714-3664
Mailing Address - Country:US
Mailing Address - Phone:808-634-5100
Mailing Address - Fax:
Practice Address - Street 1:9874 W SLEEPY HOLLOW LN
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83714-3664
Practice Address - Country:US
Practice Address - Phone:808-634-5100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-03
Last Update Date:2020-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID55538163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse