Healthcare Provider Details

I. General information

NPI: 1780646489
Provider Name (Legal Business Name): STEPHANIE ELLEN RYAN NP, CDE
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 04/06/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7166 WATERMAN AVE
UNIVERSITY CITY MO
63130-4325
US

IV. Provider business mailing address

7166 WATERMAN AVE
UNIVERSITY CITY MO
63130-4325
US

V. Phone/Fax

Practice location:
  • Phone: 314-652-4100
  • Fax: 314-289-6478
Mailing address:
  • Phone: 314-652-4100
  • Fax: 314-289-6478

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: