Healthcare Provider Details

I. General information

NPI: 1093759961
Provider Name (Legal Business Name): PATRICIA ANNE RYAN-KRAUSE R.N., M.S.N., C.P.N.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: PATRICIA ANNE RYAN

II. Dates (important events)

Enumeration Date: 06/15/2006
Last Update Date: 05/20/2021
Certification Date: 05/03/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

299 WASHINGTON AVE STE LL
HAMDEN CT
06518-3039
US

IV. Provider business mailing address

305 GREAT OAK ROAD
ORANGE CT
06477
US

V. Phone/Fax

Practice location:
  • Phone: 203-288-4288
  • Fax: 855-414-4010
Mailing address:
  • Phone: 203-376-0744
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number000412
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: