Healthcare Provider Details

I. General information

NPI: 1235632597
Provider Name (Legal Business Name): RYAN WILLIAM HUFFMAN DNP-PMHNP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/13/2018
Last Update Date: 10/26/2022
Certification Date: 10/26/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

360 SHERMAN ST # 390
SAINT PAUL MN
55102-2564
US

IV. Provider business mailing address

1283 LINCOLN AVE
SAINT PAUL MN
55105-2714
US

V. Phone/Fax

Practice location:
  • Phone: 612-924-3807
  • Fax:
Mailing address:
  • Phone: 865-200-6160
  • Fax: 503-379-1964

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN60466387
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number2484456
License Number StateMN
# 3
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number201802244RN
License Number StateOR
# 4
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number201804484NP-PP
License Number StateOR
# 5
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number7667
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: