Healthcare Provider Details

I. General information

NPI: 1417899493
Provider Name (Legal Business Name): DANIELLE RYAN RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/08/2026
Last Update Date: 04/08/2026
Certification Date: 04/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

N2643 POTATO RIDGE RD
LA CROSSE WI
54601-3006
US

IV. Provider business mailing address

N2643 POTATO RIDGE RD
LA CROSSE WI
54601-3006
US

V. Phone/Fax

Practice location:
  • Phone: 715-838-9382
  • Fax:
Mailing address:
  • Phone: 715-838-9382
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP2201X
TaxonomyAmbulatory Care Registered Nurse
License Number134456-30
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: