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NPI Code Detail

MEDICARE: MRS. PEGGY A RYAN APRN,BC,ANP

MEDICARE: MRS. PEGGY A RYAN APRN,BC,ANP
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
1363LA2200XAdult Health Nurse Practitioner71000242AIN

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
128068822AOTHERINRN
271000242BOTHERINCSR
371000242AOTHERINNURSE PRACTITIONER

General Provider Information

NPI Number : 1962490839
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. PEGGY A RYAN APRN,BC,ANP
Provider Business Mailing Address
First Line : 7887 N OLD STATE ROAD 37
Second Line :
City : BLOOMINGTON
State : IN
Zip : 47408-9443
Country : US
Telephone Number : 812-339-5677
Fax Number :
Provider Business Practice Location Address
First Line : 3512 STELLHORN RD
Second Line :
City : FORT WAYNE
State : IN
Zip : 46815-4631
Country : US
Telephone Number : 260-483-9081
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/13/2005
Last Update Date : 05/03/2013

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