Healthcare Provider Details

I. General information

NPI: 1114844644
Provider Name (Legal Business Name): AUTUMN A RYAN RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/06/2026
Last Update Date: 07/06/2026
Certification Date: 07/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1959 NE PACIFIC ST MAIN HOSPITAL ATTEN: UNIT 5SOUTH - MBU
SEATTLE WA
98195-0001
US

IV. Provider business mailing address

5512 15TH AVE NE APT 102
SEATTLE WA
98105-3435
US

V. Phone/Fax

Practice location:
  • Phone: 206-598-9594
  • Fax:
Mailing address:
  • Phone: 206-598-9594
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN60218748
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: