Provider Demographics
NPI:1336360379
Name:BRYANT, DEBORAH JO (LPN)
Entity Type:Individual
Prefix:
First Name:DEBORAH
Middle Name:JO
Last Name:BRYANT
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:299 LINCOLN PLACE
Mailing Address - Street 2:
Mailing Address - City:NORTH LEWISBURG
Mailing Address - State:OH
Mailing Address - Zip Code:43060
Mailing Address - Country:US
Mailing Address - Phone:937-844-3837
Mailing Address - Fax:
Practice Address - Street 1:299 LINCOLN PLACE
Practice Address - Street 2:
Practice Address - City:NORTH LEWISBURG
Practice Address - State:OH
Practice Address - Zip Code:43060
Practice Address - Country:US
Practice Address - Phone:937-844-3837
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN 121583164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse