Provider Demographics
NPI:1871722421
Name:WELLER, BRITTANY RYAN (LPN)
Entity type:Individual
Prefix:
First Name:BRITTANY
Middle Name:RYAN
Last Name:WELLER
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:105 CHARMOUTH DR
Mailing Address - Street 2:
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13207-1950
Mailing Address - Country:US
Mailing Address - Phone:315-863-7630
Mailing Address - Fax:
Practice Address - Street 1:105 CHARMOUTH DR
Practice Address - Street 2:
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13207-1950
Practice Address - Country:US
Practice Address - Phone:315-863-7630
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-03
Last Update Date:2009-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY297149164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse