Healthcare Provider Details

I. General information

NPI: 1669193728
Provider Name (Legal Business Name): RYAN ALYCE POWELL FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/07/2022
Last Update Date: 09/18/2023
Certification Date: 09/18/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2200 DEFENSE HWY STE 103
CROFTON MD
21114-2458
US

IV. Provider business mailing address

8201 ANNAPOLIS RD
NEW CARROLLTON MD
20784-3016
US

V. Phone/Fax

Practice location:
  • Phone: 410-721-5280
  • Fax: 410-721-2243
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberNP1032332
License Number StateDC
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberR237575
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: