Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP2300X | Nurse Practitioner - Primary Care | 905124 | MS |
NPI | 1083366975 |
---|---|
Provider Name | Marshalvia Bryant |
First Address | Greenwood, MS 38930-3436 |
Second Address | Savannah, GA 31406-4805 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 21/01/2022 |
Last Update Date | 21/01/2022 |