Healthcare Provider Details

I. General information

NPI: 1164522934
Provider Name (Legal Business Name): KATHLEEN MARY RYAN NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/22/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2238 GEARY BLVD
SAN FRANCISCO CA
94115-3416
US

IV. Provider business mailing address

2238 GEARY BLVD
SAN FRANCISCO CA
94115-3416
US

V. Phone/Fax

Practice location:
  • Phone: 415-833-4538
  • Fax: 415-833-0090
Mailing address:
  • Phone: 415-833-4538
  • Fax: 415-833-0090

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN314913
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: