Healthcare Provider Details

I. General information

NPI: 1497009062
Provider Name (Legal Business Name): STEFANIE ANNE RYAN APN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/05/2012
Last Update Date: 11/05/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 W WALNUT ST SUITE 2200
ROGERS AR
72756-3521
US

IV. Provider business mailing address

1200 W WALNUT ST SUITE 2200
ROGERS AR
72756-3521
US

V. Phone/Fax

Practice location:
  • Phone: 479-986-1300
  • Fax:
Mailing address:
  • Phone: 479-986-1300
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License NumberATP000499
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: