Healthcare Provider Details

I. General information

NPI: 1548369952
Provider Name (Legal Business Name): EUGENE EDWARD RYAN JR. C.N.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

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

5TH AVENUE & ROOSEVELT ROAD
HINES IL
60141
US

IV. Provider business mailing address

1576 TARA BELLE PKWY
NAPERVILLE IL
60564-8197
US

V. Phone/Fax

Practice location:
  • Phone: 708-202-2517
  • Fax: 708-202-2085
Mailing address:
  • Phone: 630-978-9494
  • Fax: 630-978-9494

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0809X
TaxonomyAdult Psychiatric/Mental Health Registered Nurse
License Number
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: