Individual
JENSEN D BRYAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
1741 BELLAMAH AVE NW APT 4308, ALBUQUERQUE, NM 87104-2263
(314) 974-4169
Mailing address
1741 BELLAMAH AVE NW APT 4308, ALBUQUERQUE, NM 87104-2263
(314) 974-4169
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
716
NM
Other
Enumeration date
01/10/2018
Last updated
01/10/2018
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