Healthcare Provider Details

I. General information

NPI: 1447490156
Provider Name (Legal Business Name): BRENDA SUE RYDER NNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/20/2009
Last Update Date: 02/20/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2600 SIXTH ST SW
CANTON OH
44710-1702
US

IV. Provider business mailing address

2600 SIXTH ST SW
CANTON OH
44710-1702
US

V. Phone/Fax

Practice location:
  • Phone: 330-438-7433
  • Fax: 330-580-6785
Mailing address:
  • Phone: 330-438-7433
  • Fax: 330-580-6785

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WN0002X
TaxonomyNeonatal Intensive Care Registered Nurse
License Number215841
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code363LN0005X
TaxonomyCritical Care Neonatal Nurse Practitioner
License NumberCOA10327-NP
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: