Basic Information
| Provider Information | |||||||||
| NPI: | 1588182950 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | PARADISE | ||||||||
| FirstName: | BRYAN | ||||||||
| MiddleName: | E | ||||||||
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| Mailing Information | |||||||||
| Address1: | 540 N DUKE ST STE 244 | ||||||||
| Address2: | |||||||||
| City: | LANCASTER | ||||||||
| State: | PA | ||||||||
| PostalCode: | 176022374 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7178269781 | ||||||||
| FaxNumber: | 7179455177 | ||||||||
| Practice Location | |||||||||
| Address1: | 540 N DUKE ST STE 244 | ||||||||
| Address2: | |||||||||
| City: | LANCASTER | ||||||||
| State: | PA | ||||||||
| PostalCode: | 176022374 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7178269770 | ||||||||
| FaxNumber: | 7179455177 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/06/2017 | ||||||||
| LastUpdateDate: | 03/22/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 03/22/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LA2100X | SP017604 | PA | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Acute Care |
No ID Information.