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General NPI Number Information
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NPI Number | 1336838549
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Entity Type | Individual
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Provider Name | RYAN LANCE STAAB RN
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Gender | Male
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Dates
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Enumeration Date | 05/03/2023
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Last Update Date | 09/01/2025
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Provider Practice Location Address
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Address Line | 4301 JONES BRIDGE RD
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City | BETHESDA
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State | MD
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Zip | 20814-4799
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Country | US
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Telephone | 301-295-1089
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Fax |
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Provider Business Mailing Address
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Address Line | 11217 ANTONIO SANTOS WAY
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City | EL PASO
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State | TX
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Zip | 79934-3795
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Country | US
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Telephone | 253-495-6454
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Fax |
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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 | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number | 26099
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License Number State | WY
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