Healthcare Provider Details

I. General information

NPI: 1568960045
Provider Name (Legal Business Name): RYAN GRATZER REGISTERED NURSE
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/30/2018
Last Update Date: 01/30/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7311 MEADOWHAVEN DR
CHIPPEWA LAKE OH
44215-9804
US

IV. Provider business mailing address

958 WADSWORTH RD
MEDINA OH
44256-3210
US

V. Phone/Fax

Practice location:
  • Phone: 330-321-7365
  • Fax:
Mailing address:
  • Phone: 440-897-2635
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WM0705X
TaxonomyMedical-Surgical Registered Nurse
License NumberRN.446115
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: