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General NPI Number Information
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NPI Number | 1962756460
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Entity Type | Individual
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Provider Name | MONICA CLARE RYAN PA-C
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Gender | Female
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Dates
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Enumeration Date | 11/05/2012
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Last Update Date | 02/19/2025
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Provider Practice Location Address
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Address Line | 3200 PLEASANT VALLEY RD DEPARTMENT OF UROLOGY, UROLOGIC ONCOLOGY DIVISION
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City | WEST BEND
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State | WI
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Zip | 53095
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Country | US
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Telephone | 262-836-7200
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Fax |
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Provider Business Mailing Address
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Address Line | 8701 WATERTOWN PLANK ROAD DEPARTMENT OF UROLOGY
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City | MILWAUKEE
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State | WI
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Zip | 53226-3548
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Country | US
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Telephone | 414-955-0856
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Fax | 414-955-0122
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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 | 363AS0400X
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Taxonomy Name | Surgical Physician Assistant
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License Number | 23016189
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 363AS0400X
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Taxonomy Name | Surgical Physician Assistant
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License Number | 3409
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License Number State | WI
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