Provider Demographics
NPI:1831156041
Name:BRYANT, LIZA J (PA-C)
Entity type:Individual
Prefix:
First Name:LIZA
Middle Name:J
Last Name:BRYANT
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6 PINK DOGWOOD DR
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89141-6096
Mailing Address - Country:US
Mailing Address - Phone:702-335-0899
Mailing Address - Fax:
Practice Address - Street 1:198 N G STREET
Practice Address - Street 2:
Practice Address - City:EMPIRE
Practice Address - State:CA
Practice Address - Zip Code:95319
Practice Address - Country:US
Practice Address - Phone:209-522-1010
Practice Address - Fax:209-522-1014
Is Sole Proprietor?:No
Enumeration Date:2006-05-01
Last Update Date:2024-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVPA663363A00000X
CA61069363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV1831156041Medicaid
AZ984014Medicaid
NVP00376966OtherRAILROAD MEDICARE
NVDL550XMedicare PIN
NV1831156041Medicaid
NV101793Medicare PIN
NVDL550YMedicare PIN