Basic Information
Provider Information
NPI: 1083966535
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: BRYANT
FirstName: DEBORAH
MiddleName: F
NamePrefix:  
NameSuffix:  
Credential: FNP-BC
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: PO BOX 151
Address2:  
City: NEW CASTLE
State: DE
PostalCode: 197200151
CountryCode: US
TelephoneNumber: 3026522455
FaxNumber: 3023226251
Practice Location
Address1: 404 FOX HUNT DR
Address2: FOX RUN SHOPPING CENTER
City: BEAR
State: DE
PostalCode: 197012538
CountryCode: US
TelephoneNumber: 3028362864
FaxNumber: 3029183219
Other Information
ProviderEnumerationDate: 10/09/2012
LastUpdateDate: 03/19/2020
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 03/19/2020

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
363LF0000XLG-0000688DEY Physician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily

No ID Information.


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