MEDICARE: PATRICIA LYNN RYAN NP

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	163W00000X	Registered Nurse	143319	MO
2	363LA2200X	Adult Health Nurse Practitioner	NP21692	CA

General Provider Information

NPI Number	:	1730374943
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PATRICIA LYNN RYAN NP

Provider Business Mailing Address
First Line	:	PO BOX 1007
Second Line	:
City	:	PALM SPRINGS
State	:	CA
Zip	:	92263-1007
Country	:	US
Telephone Number	:	760-668-1654
Fax Number	:	760-406-5852

Provider Business Practice Location Address
First Line	:	3001 E TAHQUITZ CANYON WAY STE 108
Second Line	:
City	:	PALM SPRINGS
State	:	CA
Zip	:	92262-6900
Country	:	US
Telephone Number	:	760-668-1654
Fax Number	:	760-406-5852

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

Provider Enumeration Date	:	09/11/2007
Last Update Date	:	05/10/2022

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