MEDICARE: JENNA ROSE RYAN NP

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	363LN0000X	Neonatal Nurse Practitioner	350601	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1144696162
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JENNA ROSE RYAN NP

Provider Business Mailing Address
First Line	:	425 NEW SCOTLAND AVE
Second Line	:
City	:	ALBANY
State	:	NY
Zip	:	12208-2726
Country	:	US
Telephone Number	:	253-348-8709
Fax Number	:

Provider Business Practice Location Address
First Line	:	315 S MANNING BLVD
Second Line	:
City	:	ALBANY
State	:	NY
Zip	:	12208-1707
Country	:	US
Telephone Number	:	518-525-1394
Fax Number	:

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

Provider Enumeration Date	:	08/13/2015
Last Update Date	:	03/12/2025

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