Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 102L00000X | Psychologist | 3324983 | AZ |
Y | 103T00000X | Psychologist | 3324983 | AZ |
NPI | 1003935396 |
---|---|
Provider Name | Natacha Tatiana Bryan |
First Address | Page, AZ 86040-1927 |
Second Address | Page, AZ 86040-1927 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/03/2007 |
Last Update Date | 08/07/2007 |