Provider Demographics
NPI:1043680051
Name:BRYAN, JACQUELINE (BA, RN, MS, CHC, WHE)
Entity type:Individual
Prefix:MRS
First Name:JACQUELINE
Middle Name:
Last Name:BRYAN
Suffix:
Gender:F
Credentials:BA, RN, MS, CHC, WHE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:51 WENTWORTH RD
Mailing Address - Street 2:
Mailing Address - City:RYE
Mailing Address - State:NH
Mailing Address - Zip Code:03870-6106
Mailing Address - Country:US
Mailing Address - Phone:603-498-2988
Mailing Address - Fax:
Practice Address - Street 1:51 WENTWORTH RD
Practice Address - Street 2:
Practice Address - City:RYE
Practice Address - State:NH
Practice Address - Zip Code:03870-6106
Practice Address - Country:US
Practice Address - Phone:603-498-2988
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-10-02
Last Update Date:2023-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
133N00000X, 133NN1002X
NH037645-21163WC1500X, 174H00000X
MA200573174H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174H00000XOther Service ProvidersHealth Educator
No133N00000XDietary & Nutritional Service ProvidersNutritionist
No133NN1002XDietary & Nutritional Service ProvidersNutritionistNutrition, Education
No163WC1500XNursing Service ProvidersRegistered NurseCommunity Health