Healthcare Provider Details

I. General information

NPI: 1871371039
Provider Name (Legal Business Name): RYAN WHITLOW RN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/19/2023
Last Update Date: 09/19/2023
Certification Date: 09/19/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2045 SILVERTON RD NE STE B
SALEM OR
97301-0100
US

IV. Provider business mailing address

967 PARK AVE NE
SALEM OR
97301-2839
US

V. Phone/Fax

Practice location:
  • Phone: 702-600-6339
  • Fax:
Mailing address:
  • Phone: 843-610-2971
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0809X
TaxonomyAdult Psychiatric/Mental Health Registered Nurse
License Number202211856RN
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: