Provider Demographics
NPI:1942904149
Name:BRYAN, BROOKE DANIELLE (WHNP-BC)
Entity Type:Individual
Prefix:MS
First Name:BROOKE
Middle Name:DANIELLE
Last Name:BRYAN
Suffix:
Gender:F
Credentials:WHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2326 BRITT ST
Mailing Address - Street 2:
Mailing Address - City:GRAYSON
Mailing Address - State:GA
Mailing Address - Zip Code:30017-1772
Mailing Address - Country:US
Mailing Address - Phone:678-956-4040
Mailing Address - Fax:
Practice Address - Street 1:500 MEDICAL CENTER BLVD STE 130
Practice Address - Street 2:
Practice Address - City:LAWRENCEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30046-3330
Practice Address - Country:US
Practice Address - Phone:470-325-1539
Practice Address - Fax:770-339-8505
Is Sole Proprietor?:No
Enumeration Date:2023-03-30
Last Update Date:2023-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN234127363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health