Provider Demographics
NPI:1932433182
Name:STINSON, BRYAN KEITH (NBCHIS)
Entity Type:Individual
Prefix:MR
First Name:BRYAN
Middle Name:KEITH
Last Name:STINSON
Suffix:
Gender:M
Credentials:NBCHIS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:700 WESTBANK EXPY
Mailing Address - Street 2:
Mailing Address - City:GRETNA
Mailing Address - State:LA
Mailing Address - Zip Code:70053-5623
Mailing Address - Country:US
Mailing Address - Phone:504-362-4556
Mailing Address - Fax:504-361-3195
Practice Address - Street 1:700 WESTBANK EXPY
Practice Address - Street 2:
Practice Address - City:GRETNA
Practice Address - State:LA
Practice Address - Zip Code:70053-5623
Practice Address - Country:US
Practice Address - Phone:504-362-4556
Practice Address - Fax:504-361-3195
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-21
Last Update Date:2009-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA919174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist