MEDICARE: KAREN RYAN BSN RN CDCES

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	163WD0400X	Diabetes Educator Registered Nurse	074792-21	NH
2	163WD0400X	Diabetes Educator Registered Nurse	RN211933	MA
3	163WD0400X	Diabetes Educator Registered Nurse	RN.541841	OH

General Provider Information

NPI Number	:	1861354359
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KAREN RYAN BSN RN CDCES

Provider Business Mailing Address
First Line	:	5885 LANDERBROOK DR STE 100
Second Line	:
City	:	MAYFIELD HTS
State	:	OH
Zip	:	44124-4031
Country	:	US
Telephone Number	:	440-995-3839
Fax Number	:

Provider Business Practice Location Address
First Line	:	5885 LANDERBROOK DR STE 100
Second Line	:
City	:	MAYFIELD HTS
State	:	OH
Zip	:	44124-4031
Country	:	US
Telephone Number	:	440-995-3839
Fax Number	:

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

Provider Enumeration Date	:	12/02/2025
Last Update Date	:	12/02/2025

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