Healthcare Provider Details

I. General information

NPI: 1689834210
Provider Name (Legal Business Name): CAROLYN S. RYAN A.C.A.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/17/2008
Last Update Date: 06/17/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12801 MIDWAY RD #403
DALLAS TX
75244-6813
US

IV. Provider business mailing address

12801 MIDWAY RD #403
DALLAS TX
75244-6813
US

V. Phone/Fax

Practice location:
  • Phone: 972-247-1377
  • Fax: 972-484-8851
Mailing address:
  • Phone: 972-247-1377
  • Fax: 972-484-8851

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License Number50169
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: