Provider Demographics
NPI:1336727981
Name:BRYANT, LORI
Entity type:Individual
Prefix:
First Name:LORI
Middle Name:
Last Name:BRYANT
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 1:221 ASHLYNN CT
Mailing Address - Street 2:
Mailing Address - City:NEWTON FALLS
Mailing Address - State:OH
Mailing Address - Zip Code:44444-8768
Mailing Address - Country:US
Mailing Address - Phone:330-307-1130
Mailing Address - Fax:
Practice Address - Street 1:325 W BROAD ST
Practice Address - Street 2:
Practice Address - City:NEWTON FALLS
Practice Address - State:OH
Practice Address - Zip Code:44444-1272
Practice Address - Country:US
Practice Address - Phone:330-872-4442
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-01
Last Update Date:2021-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN.342490163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse