Healthcare Provider Details

I. General information

NPI: 1902669476
Provider Name (Legal Business Name): RYAN FLACH
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/06/2024
Last Update Date: 12/04/2025
Certification Date: 12/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 STATE ST
ERIE PA
16550-0002
US

IV. Provider business mailing address

718 W 3RD ST
ERIE PA
16507-1117
US

V. Phone/Fax

Practice location:
  • Phone: 203-751-3364
  • Fax:
Mailing address:
  • Phone: 203-751-3364
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number15931
License Number StateCT
# 2
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberRN744096
License Number StatePA
# 3
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN744096
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: