Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TR0400X | Rehabilitation Psychologist |
NPI | 1114351723 |
---|---|
Provider Name | Angela Bryant |
First Address | Las Vegas, NV 89146-0394 |
Second Address | Las Vegas, NV 89146-0394 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 30/08/2013 |
Last Update Date | 30/08/2013 |