Provider Demographics
NPI:1154723583
Name:BRYNER, SALLY BETH (MSN, PRN,FNP-BD,CLC)
Entity type:Individual
Prefix:
First Name:SALLY
Middle Name:BETH
Last Name:BRYNER
Suffix:
Gender:F
Credentials:MSN, PRN,FNP-BD,CLC
Other - Prefix:
Other - First Name:SALLY
Other - Middle Name:BETH
Other - Last Name:GRANT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:873 COUNTY ROAD 66
Mailing Address - Street 2:
Mailing Address - City:HEMINGFORD
Mailing Address - State:NE
Mailing Address - Zip Code:69348-2005
Mailing Address - Country:US
Mailing Address - Phone:308-762-2534
Mailing Address - Fax:308-762-2764
Practice Address - Street 1:2091 BOX BUTTE AVE
Practice Address - Street 2:SUITE 500
Practice Address - City:ALLIANCE
Practice Address - State:NE
Practice Address - Zip Code:69301-4452
Practice Address - Country:US
Practice Address - Phone:308-762-2534
Practice Address - Fax:308-762-2764
Is Sole Proprietor?:No
Enumeration Date:2014-09-17
Last Update Date:2014-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE111738207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine