Provider Demographics
NPI:1912988957
Name:BRYAN, REBECCA HILGEN (AGPCNP, APN)
Entity Type:Individual
Prefix:DR
First Name:REBECCA
Middle Name:HILGEN
Last Name:BRYAN
Suffix:
Gender:F
Credentials:AGPCNP, APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:124 W SUMMIT AVE
Mailing Address - Street 2:
Mailing Address - City:HADDONFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:08033-3318
Mailing Address - Country:US
Mailing Address - Phone:856-429-7491
Mailing Address - Fax:856-482-8057
Practice Address - Street 1:124 W SUMMIT AVE
Practice Address - Street 2:
Practice Address - City:HADDONFIELD
Practice Address - State:NJ
Practice Address - Zip Code:08033-3318
Practice Address - Country:US
Practice Address - Phone:856-986-8594
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-08
Last Update Date:2021-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NN06026000363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJS46946Medicare UPIN
NJBR004205Medicare ID - Type Unspecified