Healthcare Provider Details

I. General information

NPI: 1427945575
Provider Name (Legal Business Name): PATRICK RYAN JR. FNP-BC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/20/2025
Last Update Date: 09/18/2026
Certification Date: 09/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

212 N MAIN ST RM 300
NORTH WALES PA
19454-3129
US

IV. Provider business mailing address

212 N MAIN ST RM 300
NORTH WALES PA
19454-3129
US

V. Phone/Fax

Practice location:
  • Phone: 215-481-2000
  • Fax:
Mailing address:
  • Phone: 215-481-2000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number0000000000000000
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: