Healthcare Provider Details

I. General information

NPI: 1801891999
Provider Name (Legal Business Name): TONI B RYAN NP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/16/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7446 SHALLOWFORD RD SUITE 205
CHATTANOOGA TN
37421-8815
US

IV. Provider business mailing address

7446 SHALLOWFORD RD SUITE 20-5
CHATTANOOGA TN
37421-8815
US

V. Phone/Fax

Practice location:
  • Phone: 423-648-4011
  • Fax: 423-648-4014
Mailing address:
  • Phone: 423-648-4011
  • Fax: 423-648-4014

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number98893
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: