Provider Demographics
NPI:1740099803
Name:BRYAN, COLLEEN YVONNE
Entity type:Individual
Prefix:
First Name:COLLEEN
Middle Name:YVONNE
Last Name:BRYAN
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 1:246 YORK BAY TRL
Mailing Address - Street 2:
Mailing Address - City:WEST HENRIETTA
Mailing Address - State:NY
Mailing Address - Zip Code:14586-9118
Mailing Address - Country:US
Mailing Address - Phone:657-272-9940
Mailing Address - Fax:
Practice Address - Street 1:246 YORK BAY TRL
Practice Address - Street 2:
Practice Address - City:WEST HENRIETTA
Practice Address - State:NY
Practice Address - Zip Code:14586-9118
Practice Address - Country:US
Practice Address - Phone:657-272-9940
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-01-03
Last Update Date:2025-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY34952201164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse