Healthcare Provider Details

I. General information

NPI: 1669776316
Provider Name (Legal Business Name): DENITA RYAN ANP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/10/2011
Last Update Date: 01/10/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

350 W THOMAS RD
PHOENIX AZ
85013-4409
US

IV. Provider business mailing address

350 W THOMAS RD
PHOENIX AZ
85013-4409
US

V. Phone/Fax

Practice location:
  • Phone: 602-406-4749
  • Fax:
Mailing address:
  • Phone: 602-406-4749
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WN0800X
TaxonomyNeuroscience Registered Nurse
License Number029595
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: