Provider Demographics
NPI:1568358265
Name:BRYAN, NOEL ELIZABETH (LPN)
Entity type:Individual
Prefix:
First Name:NOEL
Middle Name:ELIZABETH
Last Name:BRYAN
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:NOEL
Other - Middle Name:ELIZABETH
Other - Last Name:KODER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPN
Mailing Address - Street 1:2247 HOMEWOOD WAY
Mailing Address - Street 2:
Mailing Address - City:CARMICHAEL
Mailing Address - State:CA
Mailing Address - Zip Code:95608-5055
Mailing Address - Country:US
Mailing Address - Phone:501-286-5018
Mailing Address - Fax:
Practice Address - Street 1:935 SPRING ST # B
Practice Address - Street 2:
Practice Address - City:PLACERVILLE
Practice Address - State:CA
Practice Address - Zip Code:95667-4543
Practice Address - Country:US
Practice Address - Phone:530-621-6213
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-06-17
Last Update Date:2025-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA751500164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse