Provider Demographics
NPI:1053994988
Name:BRYANT, RICHARD D (LPN)
Entity type:Individual
Prefix:
First Name:RICHARD
Middle Name:D
Last Name:BRYANT
Suffix:
Gender:M
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8101 EUCLID AVE
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44103-5059
Mailing Address - Country:US
Mailing Address - Phone:216-600-0208
Mailing Address - Fax:216-228-8179
Practice Address - Street 1:8101 EUCLID AVE
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44103-5059
Practice Address - Country:US
Practice Address - Phone:216-600-0208
Practice Address - Fax:216-229-8179
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-29
Last Update Date:2023-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
343900000X
OHLPN155107164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
No343900000XTransportation ServicesNon-emergency Medical Transport (VAN)