Provider Demographics
NPI:1831773449
Name:BRYSON, ANGALA DEE
Entity type:Individual
Prefix:
First Name:ANGALA
Middle Name:DEE
Last Name:BRYSON
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 1:1262 FIR AVE
Mailing Address - Street 2:
Mailing Address - City:ROOSEVELT
Mailing Address - State:UT
Mailing Address - Zip Code:84066-3820
Mailing Address - Country:US
Mailing Address - Phone:801-455-7492
Mailing Address - Fax:
Practice Address - Street 1:1262 FIR AVE
Practice Address - Street 2:
Practice Address - City:ROOSEVELT
Practice Address - State:UT
Practice Address - Zip Code:84066-3820
Practice Address - Country:US
Practice Address - Phone:801-455-7492
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-05-10
Last Update Date:2022-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT8026005-3102163W00000X
UT8026005-8900363L00000X
UT8026005-4405363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163W00000XNursing Service ProvidersRegistered Nurse