Healthcare Provider Details

I. General information

NPI: 1649164302
Provider Name (Legal Business Name): RYAN CALMES
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/06/2025
Last Update Date: 06/06/2025
Certification Date: 06/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4236 N SHADYWOOD CT
APPLETON WI
54913-2318
US

IV. Provider business mailing address

3100 E LOURDES DR
APPLETON WI
54915-3927
US

V. Phone/Fax

Practice location:
  • Phone: 920-851-2345
  • Fax:
Mailing address:
  • Phone: 920-851-2345
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code311ZA0620X
TaxonomyAdult Care Home Facility
License Number18319
License Number StateWI
# 2
Primary TaxonomyY
Taxonomy Code311ZA0620X
TaxonomyAdult Care Home Facility
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: