Provider Demographics
NPI:1104473941
Name:BRIANT, MAEGAN
Entity type:Individual
Prefix:
First Name:MAEGAN
Middle Name:
Last Name:BRIANT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4689 WOODHURST DR APT 3
Mailing Address - Street 2:
Mailing Address - City:YOUNGSTOWN
Mailing Address - State:OH
Mailing Address - Zip Code:44515-3741
Mailing Address - Country:US
Mailing Address - Phone:724-413-2934
Mailing Address - Fax:
Practice Address - Street 1:4689 WOODHURST DR APT 3
Practice Address - Street 2:
Practice Address - City:YOUNGSTOWN
Practice Address - State:OH
Practice Address - Zip Code:44515-3741
Practice Address - Country:US
Practice Address - Phone:724-413-2934
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-26
Last Update Date:2019-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training ProgramGroup - Single Specialty