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General NPI Number Information
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NPI Number | 1861739641
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Entity Type | Individual
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Provider Name | ANNA S RYAN APN
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Gender | Female
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Dates
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Enumeration Date | 01/13/2013
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Last Update Date | 01/13/2013
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Provider Practice Location Address
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Address Line | 2160 S 1ST AVE
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City | MAYWOOD
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State | IL
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Zip | 60153-3328
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Country | US
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Telephone | 708-216-3208
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Fax | 708-216-4948
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Provider Business Mailing Address
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Address Line | 787 GRACELAND AVE UNIT 604B
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City | DES PLAINES
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State | IL
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Zip | 60016-8632
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Country | US
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Telephone | 224-567-8219
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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 | 363LA2100X
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Taxonomy Name | Acute Care Nurse Practitioner
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License Number | 209009917
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License Number State | IL
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