Provider Demographics
NPI:1104136704
Name:O'BRYAN, NANCY J (RN)
Entity type:Individual
Prefix:
First Name:NANCY
Middle Name:J
Last Name:O'BRYAN
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:405 REED RD
Mailing Address - Street 2:APT. E
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45440-4554
Mailing Address - Country:US
Mailing Address - Phone:214-797-1344
Mailing Address - Fax:
Practice Address - Street 1:405 REED RD
Practice Address - Street 2:APT. E
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45440-4554
Practice Address - Country:US
Practice Address - Phone:214-797-1344
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-15
Last Update Date:2010-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN.346725163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse