Healthcare Provider Details

I. General information

NPI: 1861354359
Provider Name (Legal Business Name): KAREN RYAN BSN RN CDCES
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/02/2025
Last Update Date: 12/02/2025
Certification Date: 12/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5885 LANDERBROOK DR STE 100
MAYFIELD HTS OH
44124-4031
US

IV. Provider business mailing address

5885 LANDERBROOK DR STE 100
MAYFIELD HTS OH
44124-4031
US

V. Phone/Fax

Practice location:
  • Phone: 440-995-3839
  • Fax:
Mailing address:
  • Phone: 440-995-3839
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WD0400X
TaxonomyDiabetes Educator Registered Nurse
License Number074792-21
License Number StateNH
# 2
Primary TaxonomyN
Taxonomy Code163WD0400X
TaxonomyDiabetes Educator Registered Nurse
License NumberRN211933
License Number StateMA
# 3
Primary TaxonomyY
Taxonomy Code163WD0400X
TaxonomyDiabetes Educator Registered Nurse
License NumberRN.541841
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: