Healthcare Provider Details

I. General information

NPI: 1851740427
Provider Name (Legal Business Name): MR. RYAN WADE ARMSTRONG
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/06/2016
Last Update Date: 06/06/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5713 GRAND RIVER RD
RIVES JUNCTION MI
49277-9684
US

IV. Provider business mailing address

5713 GRAND RIVER RD
RIVES JUNCTION MI
49277-9684
US

V. Phone/Fax

Practice location:
  • Phone: 517-748-3220
  • Fax:
Mailing address:
  • Phone: 517-748-3220
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code247200000X
TaxonomyOther Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: