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General NPI Number Information
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NPI Number | 1043220593
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Entity Type | Individual
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Provider Name | JUDITH W. RYAN CRNP
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Gender | Female
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Dates
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Enumeration Date | 08/08/2006
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Last Update Date | 07/09/2007
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Provider Practice Location Address
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Address Line | 10989 RED RUN BLVD SUITE 208
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City | OWINGS MILLS
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State | MD
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Zip | 21117-3283
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Country | US
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Telephone | 410-654-8602
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Fax | 410-654-8709
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Provider Business Mailing Address
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Address Line | 1514 WOODSIDE AVE
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City | BALTIMORE
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State | MD
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Zip | 21227-4038
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Country | US
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Telephone | 410-654-8602
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Fax | 410-654-8709
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LA2200X
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Taxonomy Name | Adult Health Nurse Practitioner
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License Number | R051691
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License Number State | MD
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