Provider Demographics
NPI:1265764138
Name:BRYANT, MARCIE ANN (RN, CNM)
Entity type:Individual
Prefix:
First Name:MARCIE
Middle Name:ANN
Last Name:BRYANT
Suffix:
Gender:F
Credentials:RN, CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:890 PREAKNESS DR
Mailing Address - Street 2:
Mailing Address - City:GREENWOOD
Mailing Address - State:IN
Mailing Address - Zip Code:46143-8173
Mailing Address - Country:US
Mailing Address - Phone:317-408-4366
Mailing Address - Fax:
Practice Address - Street 1:2110 W 38TH ST
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46228-3202
Practice Address - Country:US
Practice Address - Phone:317-328-0671
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-02-03
Last Update Date:2010-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN09000156A367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife