Healthcare Provider Details

I. General information

NPI: 1760211627
Provider Name (Legal Business Name): RYAN WILLIAM MCSPEDON CRNP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/30/2024
Last Update Date: 07/30/2024
Certification Date: 07/30/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 CONVENTION AVE
PHILADELPHIA PA
19104-4311
US

IV. Provider business mailing address

1532 S CAMAC ST
PHILADELPHIA PA
19147-6208
US

V. Phone/Fax

Practice location:
  • Phone: 215-662-4000
  • Fax:
Mailing address:
  • Phone: 908-307-3889
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License NumberSP030233
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: