Provider Demographics
NPI:1003646373
Name:BRYSON, SABRENA (COO)
Entity type:Individual
Prefix:
First Name:SABRENA
Middle Name:
Last Name:BRYSON
Suffix:
Gender:F
Credentials:COO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2929 E BROADWAY RD UNIT 29
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85204-1748
Mailing Address - Country:US
Mailing Address - Phone:314-494-7603
Mailing Address - Fax:
Practice Address - Street 1:2929 E BROADWAY RD UNIT 29
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85204-1748
Practice Address - Country:US
Practice Address - Phone:314-494-7603
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-02
Last Update Date:2024-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
No171400000XOther Service ProvidersHealth & Wellness Coach
No171M00000XOther Service ProvidersCase Manager/Care Coordinator