Healthcare Provider Details

I. General information

NPI: 1023892403
Provider Name (Legal Business Name): RYAN MAHER DNP, CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/24/2023
Last Update Date: 06/13/2026
Certification Date: 06/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2500 S WOODWORTH LOOP
PALMER AK
99645-8984
US

IV. Provider business mailing address

821 N ST STE 102
ANCHORAGE AK
99501-3285
US

V. Phone/Fax

Practice location:
  • Phone: 907-861-6000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number255712
License Number StateAK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: