Provider Demographics
NPI:1184313348
Name:BRYAND, HEIDI ANN
Entity type:Individual
Prefix:
First Name:HEIDI
Middle Name:ANN
Last Name:BRYAND
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 1:4 KATIE LN
Mailing Address - Street 2:
Mailing Address - City:LOS LUNAS
Mailing Address - State:NM
Mailing Address - Zip Code:87031-8039
Mailing Address - Country:US
Mailing Address - Phone:505-238-5425
Mailing Address - Fax:
Practice Address - Street 1:4 KATIE LN
Practice Address - Street 2:
Practice Address - City:LOS LUNAS
Practice Address - State:NM
Practice Address - Zip Code:87031-8039
Practice Address - Country:US
Practice Address - Phone:505-238-5425
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-03
Last Update Date:2023-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician