Healthcare Provider Details

I. General information

NPI: 1831800473
Provider Name (Legal Business Name): RYAN BARRETT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/05/2022
Last Update Date: 05/10/2024
Certification Date: 05/06/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5151 CHURCH ST
SKOKIE IL
60077
US

IV. Provider business mailing address

303 E WACKER DR STE 1127
CHICAGO IL
60601-5215
US

V. Phone/Fax

Practice location:
  • Phone: 949-696-6157
  • Fax:
Mailing address:
  • Phone: 312-736-1776
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number209.026012
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code163WG0600X
TaxonomyGerontology Registered Nurse
License Number209.026012
License Number StateIL
# 3
Primary TaxonomyY
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License Number209.026012
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: