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General NPI Number Information
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NPI Number | 1891259743
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Entity Type | Individual
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Provider Name | WILLIAM JAMES RYAN PA-C
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Gender | Male
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Dates
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Enumeration Date | 01/24/2019
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Last Update Date | 01/24/2019
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Provider Practice Location Address
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Address Line | 2600 65TH AVE
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City | OSCEOLA
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State | WI
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Zip | 54020-4370
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Country | US
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Telephone | 715-294-2111
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Fax |
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Provider Business Mailing Address
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Address Line | 207 MYRTLE ST W APT 3
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City | STILLWATER
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State | MN
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Zip | 55082-4843
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Country | US
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Telephone | 763-232-7679
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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 | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | 12879
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License Number State | MN
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