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General NPI Number Information
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NPI Number | 1144316662
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Entity Type | Individual
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Provider Name | MICHELLE L RYAN FNP
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Gender | Female
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Dates
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Enumeration Date | 10/04/2006
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Last Update Date | 06/17/2023
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Provider Practice Location Address
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Address Line | 2554 STATE ROUTE 9
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City | BALLSTON SPA
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State | NY
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Zip | 12020-6312
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Country | US
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Telephone | 518-899-5002
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Fax | 518-899-5840
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Provider Business Mailing Address
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Address Line | PO BOX 569 848 ROUTE 50
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City | BURNT HILLS
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State | NY
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Zip | 12027-0569
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Country | US
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Telephone | 518-831-1500
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Fax | 518-377-1677
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | F333007
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License Number State | NY
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