Provider Demographics
NPI:1548076912
Name:BRYAN, NICOLE ELLEN (RN, MSN, PMHNP-BC)
Entity type:Individual
Prefix:MRS
First Name:NICOLE
Middle Name:ELLEN
Last Name:BRYAN
Suffix:
Gender:F
Credentials:RN, MSN, PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:165 PASSAIC AVE
Mailing Address - Street 2:
Mailing Address - City:FAIRFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:07004-3521
Mailing Address - Country:US
Mailing Address - Phone:800-413-8020
Mailing Address - Fax:
Practice Address - Street 1:165 PASSAIC AVE
Practice Address - Street 2:
Practice Address - City:FAIRFIELD
Practice Address - State:NJ
Practice Address - Zip Code:07004-3521
Practice Address - Country:US
Practice Address - Phone:800-413-8020
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-12-10
Last Update Date:2025-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ15228500363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health