Healthcare Provider Details

I. General information

NPI: 1578546339
Provider Name (Legal Business Name): SUZANNE MARY RYAN MSN, CNM, WHCNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/26/2005
Last Update Date: 08/09/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6115 NIEMAN RD
SHAWNEE KS
66203-2939
US

IV. Provider business mailing address

19321 SANTA FE TRL
LEAVENWORTH KS
66048-8440
US

V. Phone/Fax

Practice location:
  • Phone: 913-547-1495
  • Fax: 186-688-5969
Mailing address:
  • Phone: 913-547-1495
  • Fax: 186-688-5969

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WP2201X
TaxonomyAmbulatory Care Registered Nurse
License Number1471743111
License Number StateKS
# 2
Primary TaxonomyN
Taxonomy Code163WX0003X
TaxonomyInpatient Obstetric Registered Nurse
License Number2000162927
License Number StateMO
# 3
Primary TaxonomyN
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License Number2000162927
License Number StateMO
# 4
Primary TaxonomyN
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License Number2000162927
License Number StateMO
# 5
Primary TaxonomyY
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License Number64060
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: