Provider Demographics
NPI:1174328561
Name:BRYAN, EMILY RAYLYNN
Entity type:Individual
Prefix:
First Name:EMILY
Middle Name:RAYLYNN
Last Name:BRYAN
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1751 NE FREEMONT AVE
Mailing Address - Street 2:
Mailing Address - City:ROSEBURG
Mailing Address - State:OR
Mailing Address - Zip Code:97470-3224
Mailing Address - Country:US
Mailing Address - Phone:458-803-8349
Mailing Address - Fax:
Practice Address - Street 1:1751 NE FREEMONT AVE
Practice Address - Street 2:
Practice Address - City:ROSEBURG
Practice Address - State:OR
Practice Address - Zip Code:97470-3224
Practice Address - Country:US
Practice Address - Phone:458-803-8349
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-02-18
Last Update Date:2025-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR311ZA0620X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home