MEDICARE: MRS. JANICE SUE RYAN CFA

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	246ZS0410X	Surgical Technologist

General Provider Information

NPI Number	:	1295931053
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. JANICE SUE RYAN CFA

Provider Business Mailing Address
First Line	:	1903 OAKVIEW DR
Second Line	:
City	:	ROUND ROCK
State	:	TX
Zip	:	78681-2135
Country	:	US
Telephone Number	:	512-733-1107
Fax Number	:	512-218-0789

Provider Business Practice Location Address
First Line	:	1903 OAKVIEW DR
Second Line	:
City	:	ROUND ROCK
State	:	TX
Zip	:	78681-2135
Country	:	US
Telephone Number	:	512-733-1107
Fax Number	:	512-218-0789

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

Provider Enumeration Date	:	06/26/2007
Last Update Date	:	07/08/2007

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