MEDICARE: AMANDA MARIE RYAN FNP, DNP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163W00000X	Registered Nurse	794027	NY
2	363LF0000X	Family Nurse Practitioner	0024186531	VA

General Provider Information

NPI Number	:	1124717640
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AMANDA MARIE RYAN FNP, DNP

Provider Business Mailing Address
First Line	:	1744 FURY WAY
Second Line	:
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23456-6995
Country	:	US
Telephone Number	:	757-237-7307
Fax Number	:

Provider Business Practice Location Address
First Line	:	1744 FURY WAY
Second Line	:
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23456-6995
Country	:	US
Telephone Number	:	757-237-7307
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/02/2023
Last Update Date	:	05/20/2023

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