Healthcare Provider Details

I. General information

NPI: 1164079729
Provider Name (Legal Business Name): GRACE MARIA RYAN APRN, WHNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/19/2019
Last Update Date: 11/27/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 W CUMMINGS PARK STE 4050
WOBURN MA
01801-6372
US

IV. Provider business mailing address

800 W CUMMINGS PARK STE 4050
WOBURN MA
01801-6372
US

V. Phone/Fax

Practice location:
  • Phone: 781-787-3003
  • Fax: 781-281-2406
Mailing address:
  • Phone: 781-787-3003
  • Fax: 781-281-2406

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License NumberRN215231
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code363LX0001X
TaxonomyObstetrics & Gynecology Nurse Practitioner
License NumberRN215231
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: