MEDICARE: RYAN GRATZER REGISTERED NURSE

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	163WM0705X	Medical-Surgical Registered Nurse	RN.446115	OH

General Provider Information

NPI Number	:	1568960045
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RYAN GRATZER REGISTERED NURSE

Provider Business Mailing Address
First Line	:	958 WADSWORTH RD
Second Line	:
City	:	MEDINA
State	:	OH
Zip	:	44256-3210
Country	:	US
Telephone Number	:	440-897-2635
Fax Number	:

Provider Business Practice Location Address
First Line	:	7311 MEADOWHAVEN DR
Second Line	:
City	:	CHIPPEWA LAKE
State	:	OH
Zip	:	44215-9804
Country	:	US
Telephone Number	:	330-321-7365
Fax Number	:

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

Provider Enumeration Date	:	01/30/2018
Last Update Date	:	01/30/2018

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