Provider Demographics
NPI:1750970505
Name:BRYSON, CONSTANTIA HERMINA (REGISTERED NURSE)
Entity type:Individual
Prefix:
First Name:CONSTANTIA
Middle Name:HERMINA
Last Name:BRYSON
Suffix:
Gender:F
Credentials:REGISTERED NURSE
Other - Prefix:
Other - First Name:CONSTANTIA
Other - Middle Name:HERMINA
Other - Last Name:QUEELEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:REGISTERED NURSE
Mailing Address - Street 1:5049 COLBURN TER
Mailing Address - Street 2:
Mailing Address - City:HYATTSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20782-2350
Mailing Address - Country:US
Mailing Address - Phone:202-285-6421
Mailing Address - Fax:
Practice Address - Street 1:5049 COLBURN TER
Practice Address - Street 2:
Practice Address - City:HYATTSVILLE
Practice Address - State:MD
Practice Address - Zip Code:20782-2350
Practice Address - Country:US
Practice Address - Phone:202-285-6421
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-15
Last Update Date:2021-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR109930163WP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental HealthGroup - Single Specialty