Provider Demographics
NPI:1063145795
Name:BRYSON, TAMARA SUZETTE (REGISTERED NURSE)
Entity type:Individual
Prefix:
First Name:TAMARA
Middle Name:SUZETTE
Last Name:BRYSON
Suffix:
Gender:F
Credentials:REGISTERED NURSE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1475 BLACKMORE RD
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:44118-1314
Mailing Address - Country:US
Mailing Address - Phone:216-312-5857
Mailing Address - Fax:
Practice Address - Street 1:1475 BLACKMORE RD
Practice Address - Street 2:
Practice Address - City:CLEVELAND HEIGHTS
Practice Address - State:OH
Practice Address - Zip Code:44118-1314
Practice Address - Country:US
Practice Address - Phone:216-312-5857
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-09
Last Update Date:2022-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN308579163WC0400X, 163WA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WA0400XNursing Service ProvidersRegistered NurseAddiction (Substance Use Disorder)Group - Single Specialty
No163WC0400XNursing Service ProvidersRegistered NurseCase Management