Individual
NICHOLAS BRYANT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
5415 BENNETT DR, CROSS LANES, WV 25313-1249
(304) 380-5004
Mailing address
5415 BENNETT DR, CROSS LANES, WV 25313-1249
Taxonomy
Speciality
Code
Description
License number
State
172V00000X
Community Health Worker
Primary
—
—
Other
Enumeration date
02/13/2021
Last updated
02/13/2021
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