Individual
HOLLY MICHELLE BRYAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CRNA
Contact information
Practice address
333 LAIDLEY ST, CHARLESTON, WV 25301-1614
(304) 347-6500
Mailing address
110 ROANE ST, CHARLESTON, WV 25302-2334
(304) 344-0096
(304) 342-4725
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
68106
WV
367500000X
Certified Registered Nurse Anesthetist
Primary
085364
WV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3810020866
—
WV
01
—
P00981778
MEDICARE RAILROAD
WV
01
—
Q37422A
MEDICARE PTAN
WV
Enumeration date
07/12/2011
Last updated
09/28/2017
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