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General NPI Number Information
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NPI Number | 1346789351
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Entity Type | Individual
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Provider Name | JEFFREY RYCK CRNP
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Gender | Male
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Dates
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Enumeration Date | 02/23/2017
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Last Update Date | 01/17/2023
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Provider Practice Location Address
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Address Line | 3101 SHIPPERS RD
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City | VESTAL
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State | NY
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Zip | 13850-2080
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Country | US
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Telephone | 607-250-2180
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Fax |
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Provider Business Mailing Address
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Address Line | 215 YORK AVE
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City | TOWANDA
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State | PA
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Zip | 18848-1933
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Country | US
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Telephone | 570-881-0202
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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 | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | SP017224
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License Number State | PA
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