Provider Demographics
NPI:1669203782
Name:BRYAN, MARIKO (RN BSN)
Entity type:Individual
Prefix:MS
First Name:MARIKO
Middle Name:
Last Name:BRYAN
Suffix:
Gender:F
Credentials:RN BSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 551
Mailing Address - Street 2:
Mailing Address - City:WHITEFISH
Mailing Address - State:MT
Mailing Address - Zip Code:59937-0551
Mailing Address - Country:US
Mailing Address - Phone:808-727-0223
Mailing Address - Fax:
Practice Address - Street 1:PO BOX 551
Practice Address - Street 2:
Practice Address - City:WHITEFISH
Practice Address - State:MT
Practice Address - Zip Code:59937-0551
Practice Address - Country:US
Practice Address - Phone:808-727-0223
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-10
Last Update Date:2024-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTRN72056163WD0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WD0400XNursing Service ProvidersRegistered NurseDiabetes Educator