MEDICARE: DR. NATHAN RYAN DEAN PH.D., L.P.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TC1900X	Counseling Psychologist	LP5397	MN

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	680003248	OTHER	MN	MEDICARE PTAN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1528343738
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. NATHAN RYAN DEAN PH.D., L.P.

Provider Business Mailing Address
First Line	:	1041 GRAND AVE # 325
Second Line	:
City	:	SAINT PAUL
State	:	MN
Zip	:	55105-3002
Country	:	US
Telephone Number	:	651-231-9936
Fax Number	:	651-647-5723

Provider Business Practice Location Address
First Line	:	1041 GRAND AVE # 325
Second Line	:
City	:	SAINT PAUL
State	:	MN
Zip	:	55105-3002
Country	:	US
Telephone Number	:	651-231-9936
Fax Number	:	651-647-5723

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/19/2011
Last Update Date	:	05/31/2024

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