Provider Demographics
NPI:1942538889
Name:BRYANT, LORETTA PAULETTE (LPN)
Entity Type:Individual
Prefix:
First Name:LORETTA
Middle Name:PAULETTE
Last Name:BRYANT
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:LORETTA
Other - Middle Name:PAULETTE
Other - Last Name:STONE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 2845
Mailing Address - Street 2:
Mailing Address - City:RICHMOND HILL
Mailing Address - State:GA
Mailing Address - Zip Code:31324-2845
Mailing Address - Country:US
Mailing Address - Phone:912-713-5151
Mailing Address - Fax:
Practice Address - Street 1:4915 US HIGHWAY 17
Practice Address - Street 2:LOT B 27
Practice Address - City:RICHMOND HILL
Practice Address - State:GA
Practice Address - Zip Code:31324-8808
Practice Address - Country:US
Practice Address - Phone:912-713-5151
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-12-04
Last Update Date:2009-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPN063099164W00000X
NH013425-22164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse