Healthcare Provider Details

I. General information

NPI: 1043725112
Provider Name (Legal Business Name): EMILY ELIZABETH RADFORD RYAN DNP, FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/11/2017
Last Update Date: 12/07/2020
Certification Date: 12/03/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

414 EAST MAIN STREET CLINIC 6
DURHAM NC
27701
US

IV. Provider business mailing address

2706 ELLEN ST
DURHAM NC
27705-2034
US

V. Phone/Fax

Practice location:
  • Phone: 919-560-7600
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number5010102
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: