Provider Demographics
NPI:1952715229
Name:BRYANT, NICOLE (LPN)
Entity Type:Individual
Prefix:MS
First Name:NICOLE
Middle Name:
Last Name:BRYANT
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8806 RAY CT APT 1
Mailing Address - Street 2:
Mailing Address - City:TWINSBURG
Mailing Address - State:OH
Mailing Address - Zip Code:44087-2087
Mailing Address - Country:US
Mailing Address - Phone:234-212-9123
Mailing Address - Fax:
Practice Address - Street 1:8806 RAY CT APT 1
Practice Address - Street 2:
Practice Address - City:TWINSBURG
Practice Address - State:OH
Practice Address - Zip Code:44087-2087
Practice Address - Country:US
Practice Address - Phone:234-212-9123
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-16
Last Update Date:2014-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN.156352-M-IV164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse