Provider Demographics
NPI:1720808942
Name:BRYAN, JOHANNA (NBC-HWC)
Entity type:Individual
Prefix:
First Name:JOHANNA
Middle Name:
Last Name:BRYAN
Suffix:
Gender:F
Credentials:NBC-HWC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3515 W 152ND ST
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44111-2112
Mailing Address - Country:US
Mailing Address - Phone:608-695-1049
Mailing Address - Fax:
Practice Address - Street 1:4400 EASTON CMNS STE 125
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43219-6223
Practice Address - Country:US
Practice Address - Phone:800-516-0975
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-14
Last Update Date:2024-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171400000XOther Service ProvidersHealth & Wellness Coach