1801950282 NPI number — MS. CAROL ANN BRYNIARSKI NURSE PRACTITIONER

Table of content: MS. CAROL ANN BRYNIARSKI NURSE PRACTITIONER (NPI 1801950282)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1801950282 NPI number — MS. CAROL ANN BRYNIARSKI NURSE PRACTITIONER

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BRYNIARSKI
Provider First Name:
CAROL
Provider Middle Name:
ANN
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
NURSE PRACTITIONER
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1801950282
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/07/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7561 E LA CIENEGA DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
TUCSON
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
85715-3526
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
520-733-1537
Provider Business Mailing Address Fax Number:
520-886-2369

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2122 N CRAYCROFT RD
Provider Second Line Business Practice Location Address:
SUITE 102
Provider Business Practice Location Address City Name:
TUCSON
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85712-2849
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
520-722-2400
Provider Business Practice Location Address Fax Number:
520-323-7531
Provider Enumeration Date:
12/20/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363LG0600X , with the licence number:  CERTIFICATE NO. 17 , registered in the state of AZ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 527509 , issued by the state of ( AZ ) . This identifiers is of the category "MEDICAID".




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