Provider Demographics
NPI:1730546953
Name:BRYANT, BETHANIE LOREN (CD(DONA), CLC)
Entity type:Individual
Prefix:
First Name:BETHANIE
Middle Name:LOREN
Last Name:BRYANT
Suffix:
Gender:F
Credentials:CD(DONA), CLC
Other - Prefix:
Other - First Name:BETHANIE
Other - Middle Name:LOREN
Other - Last Name:VERDUZCO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:CD(DONA), CLC
Mailing Address - Street 1:4938 S DETROIT AVE
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74105-4610
Mailing Address - Country:US
Mailing Address - Phone:918-938-3436
Mailing Address - Fax:
Practice Address - Street 1:4938 S DETROIT AVE
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74105-4610
Practice Address - Country:US
Practice Address - Phone:918-938-3436
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-01-19
Last Update Date:2016-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula