Healthcare Provider Details

I. General information

NPI: 1316342843
Provider Name (Legal Business Name): LISA MARIE RYAN APN, FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/27/2014
Last Update Date: 12/17/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30 SHREWSBURY PLZ
SHREWSBURY NJ
07702-4322
US

IV. Provider business mailing address

PO BOX 8519
RED BANK NJ
07701-8519
US

V. Phone/Fax

Practice location:
  • Phone: 732-542-2992
  • Fax: 732-542-2992
Mailing address:
  • Phone: 732-460-9840
  • Fax: 732-460-9848

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number26NJ00527800
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: