Healthcare Provider Details

I. General information

NPI: 1467585240
Provider Name (Legal Business Name): JOHN RYAN MCLANE BSN, MPH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/13/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5TH AVENUE AND BERING STREET
NOME AK
99762
US

IV. Provider business mailing address

PO BOX 1169
NOME AK
99762-1169
US

V. Phone/Fax

Practice location:
  • Phone: 907-443-3302
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC1500X
TaxonomyCommunity Health Registered Nurse
License Number18790
License Number StateAK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: