Provider Demographics
NPI:1073307450
Name:BRYAN, KAREN (BSN, RN)
Entity type:Individual
Prefix:
First Name:KAREN
Middle Name:
Last Name:BRYAN
Suffix:
Gender:
Credentials:BSN, RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1314 E ADELINE AVE
Mailing Address - Street 2:
Mailing Address - City:COEUR D ALENE
Mailing Address - State:ID
Mailing Address - Zip Code:83814-4460
Mailing Address - Country:US
Mailing Address - Phone:949-423-9212
Mailing Address - Fax:
Practice Address - Street 1:1314 E ADELINE AVE
Practice Address - Street 2:
Practice Address - City:COEUR D ALENE
Practice Address - State:ID
Practice Address - Zip Code:83814-4460
Practice Address - Country:US
Practice Address - Phone:949-423-9212
Practice Address - Fax:949-423-9212
Is Sole Proprietor?:Yes
Enumeration Date:2025-04-08
Last Update Date:2025-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID55144163WC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC0200XNursing Service ProvidersRegistered NurseCritical Care Medicine