Healthcare Provider Details

I. General information

NPI: 1417292079
Provider Name (Legal Business Name): PATRICIA RYAN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/06/2012
Last Update Date: 12/06/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

130 PORT WILLIAMS RD
SEQUIM WA
98382-3146
US

IV. Provider business mailing address

130 PORT WILLIAMS RD
SEQUIM WA
98382-3146
US

V. Phone/Fax

Practice location:
  • Phone: 360-681-7479
  • Fax: 360-681-7479
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133NN1002X
TaxonomyNutrition Education Nutritionist
License Number601568466
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code173C00000X
TaxonomyReflexologist
License Number601568466
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: