Provider Demographics
NPI:1316064272
Name:BRYAN, NANCY ELIZABETH (DO)
Entity type:Individual
Prefix:DR
First Name:NANCY
Middle Name:ELIZABETH
Last Name:BRYAN
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15905 S FREDERICK ST
Mailing Address - Street 2:STE 105
Mailing Address - City:PLAINFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:60586-7707
Mailing Address - Country:US
Mailing Address - Phone:630-646-5020
Mailing Address - Fax:630-646-5025
Practice Address - Street 1:15905 S FREDERICK ST
Practice Address - Street 2:STE 105
Practice Address - City:PLAINFIELD
Practice Address - State:IL
Practice Address - Zip Code:60586-7707
Practice Address - Country:US
Practice Address - Phone:630-646-5020
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-24
Last Update Date:2008-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036.117275207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL2220936OtherBCBS
IL036117275 1Medicaid
IL036117275 1Medicaid
IL2220936OtherBCBS