Healthcare Provider Details

I. General information

NPI: 1841495827
Provider Name (Legal Business Name): TIFFANY MARIE RYAN LPN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/19/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

413 N MOUNT VERNON AVE
LOUDONVILLE OH
44842-1138
US

IV. Provider business mailing address

413 N MOUNT VERNON AVE
LOUDONVILLE OH
44842-1138
US

V. Phone/Fax

Practice location:
  • Phone: 419-651-3737
  • Fax:
Mailing address:
  • Phone: 419-651-3737
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License NumberPN 118461
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: