Most Relevant Information
Provider Data
| NPI Number: | 1003571050 |
| Provider Name: | ETHAN BRYANT |
| Entity Type: | Individual |
| Taxonomy Code: | 172V00000X |
| Specialty: | Community Health Worker |
| License Number: |
Most Important Dates
| Enumeration Date: | 11/04/2021 |
| Last Updated: | 11/04/2021 |
Provider Practice Location
200 ASSOCIATION DR STE 130
CHARLESTON
WV
253111277
Practice Location Phone/Fax
| Phone: | 3049884200 |
| Fax: |
Provider Mailing Location
200 ASSOCIATION DR STE 130
CHARLESTON
WV
253111277
Provider Mailing Phone/Fax
| Phone: | 3049884200 |
| Fax: |