MEDICARE: MRS. CAROLYN S. RYAN A.C.A.

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	237700000X	Hearing Instrument Specialist	50169	TX

General Provider Information

NPI Number	:	1689834210
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. CAROLYN S. RYAN A.C.A.

Provider Business Mailing Address
First Line	:	12801 MIDWAY RD
Second Line	:	#403
City	:	DALLAS
State	:	TX
Zip	:	75244-6813
Country	:	US
Telephone Number	:	972-247-1377
Fax Number	:	972-484-8851

Provider Business Practice Location Address
First Line	:	12801 MIDWAY RD
Second Line	:	#403
City	:	DALLAS
State	:	TX
Zip	:	75244-6813
Country	:	US
Telephone Number	:	972-247-1377
Fax Number	:	972-484-8851

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

Provider Enumeration Date	:	06/17/2008
Last Update Date	:	06/17/2008

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