Individual
MIRJAM BRYAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
4825 S LABURNUM AVE, RICHMOND, VA 23231-2713
(804) 727-8101
Mailing address
4825 S LABURNUM AVE, RICHMOND, VA 23231-2713
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
0110004713
VA
363A00000X
Physician Assistant
0110004713
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0110004713
PA-LICENSE
VA
05
—
0110004713
—
VA
Enumeration date
09/26/2014
Last updated
03/01/2019
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