Provider Demographics
NPI:1821819129
Name:BRYAN, EDITH GAIL
Entity type:Individual
Prefix:MRS
First Name:EDITH
Middle Name:GAIL
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 1:2512 4TH ST W
Mailing Address - Street 2:
Mailing Address - City:ASHLAND
Mailing Address - State:KY
Mailing Address - Zip Code:41102-4201
Mailing Address - Country:US
Mailing Address - Phone:606-615-6731
Mailing Address - Fax:
Practice Address - Street 1:2512 4TH ST W
Practice Address - Street 2:
Practice Address - City:ASHLAND
Practice Address - State:KY
Practice Address - Zip Code:41102-4201
Practice Address - Country:US
Practice Address - Phone:606-615-6731
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-18
Last Update Date:2024-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant