Provider Demographics
NPI:1366048118
Name:BRYANT, ASANTEWA R
Entity type:Individual
Prefix:MRS
First Name:ASANTEWA
Middle Name:R
Last Name:BRYANT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2699 E 20TH ST APT A
Mailing Address - Street 2:
Mailing Address - City:SIGNAL HILL
Mailing Address - State:CA
Mailing Address - Zip Code:90755-1057
Mailing Address - Country:US
Mailing Address - Phone:513-267-1649
Mailing Address - Fax:
Practice Address - Street 1:2699 E 20TH ST APT A
Practice Address - Street 2:
Practice Address - City:SIGNAL HILL
Practice Address - State:CA
Practice Address - Zip Code:90755-1057
Practice Address - Country:US
Practice Address - Phone:513-267-1649
Practice Address - Fax:562-343-1431
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-08
Last Update Date:2024-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA719417164X00000X
OH156277164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
No164X00000XNursing Service ProvidersLicensed Vocational Nurse