Individual
DAVIDA BRYANT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
100 S 4TH ST STE 550, SAINT LOUIS, MO 63102-1897
(636) 735-0898
Mailing address
100 S 4TH ST STE 550, SAINT LOUIS, MO 63102-1897
(636) 735-0898
Taxonomy
Speciality
Code
Description
License number
State
251E00000X
Home Health Agency
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
123456789
—
MO
Enumeration date
01/11/2018
Last updated
06/16/2018
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