Provider Demographics
NPI:1619714292
Name:BRYAN, SAMANTHA RAE (FNP-C)
Entity type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:RAE
Last Name:BRYAN
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:113 PONDEROSA DR
Mailing Address - Street 2:
Mailing Address - City:MILES CITY
Mailing Address - State:MT
Mailing Address - Zip Code:59301-5812
Mailing Address - Country:US
Mailing Address - Phone:406-852-6711
Mailing Address - Fax:
Practice Address - Street 1:305 S 4TH ST
Practice Address - Street 2:
Practice Address - City:MILES CITY
Practice Address - State:MT
Practice Address - Zip Code:59301-4175
Practice Address - Country:US
Practice Address - Phone:406-874-8700
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-11
Last Update Date:2024-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTNUR-APRN-LIC-240693363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily