Healthcare Provider Details

I. General information

NPI: 1447921440
Provider Name (Legal Business Name): BRITTANY RYAN RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/21/2021
Last Update Date: 09/21/2021
Certification Date: 09/21/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1015 BOWLES AVE
FENTON MO
63026-2394
US

IV. Provider business mailing address

2678 RIDGE DR
HIGH RIDGE MO
63049-2324
US

V. Phone/Fax

Practice location:
  • Phone: 636-496-2000
  • Fax:
Mailing address:
  • Phone: 314-954-6781
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC0200X
TaxonomyCritical Care Medicine Registered Nurse
License Number2010031591
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: