Healthcare Provider Details

I. General information

NPI: 1891619011
Provider Name (Legal Business Name): ELIZABETH MAE RYAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/10/2026
Last Update Date: 08/10/2026
Certification Date: 08/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

378 N BURROWES RD
STATE COLLEGE PA
16802-4508
US

IV. Provider business mailing address

712 TYLER AVE
CLEARFIELD PA
16830-1327
US

V. Phone/Fax

Practice location:
  • Phone: 814-863-1163
  • Fax:
Mailing address:
  • Phone: 814-414-6807
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: