Provider Demographics
NPI:1568650950
Name:BRYAN, SUSAN A (ANP)
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:A
Last Name:BRYAN
Suffix:
Gender:F
Credentials:ANP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4341 TUDOR CENTRE DR
Mailing Address - Street 2:3RD FLOOR
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99508-5904
Mailing Address - Country:US
Mailing Address - Phone:907-729-2500
Mailing Address - Fax:
Practice Address - Street 1:4341 TUDOR CENTRE DR
Practice Address - Street 2:3RD FLOOR
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99508-5904
Practice Address - Country:US
Practice Address - Phone:907-729-2500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-10-10
Last Update Date:2023-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK987363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
AK8EL772Medicare PIN
AK8EL773Medicare PIN
AK8EE751Medicare PIN
AKNP66781Medicaid
AK8EL774Medicare PIN
AK8EL769Medicare PIN
AK8EL771Medicare PIN
AK8EE750Medicare PIN
AK8EL770Medicare PIN