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NPI Code Detail

MEDICARE: C.M. RYAN NURSE PRACTITIONER ADULT HEALTH, PLLC

MEDICARE: C.M. RYAN NURSE PRACTITIONER ADULT HEALTH, PLLC
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
1363LA2200XAdult Health Nurse Practitioner304651NY

General Provider Information

NPI Number : 1487922910
Entity Type Code : Organization
Provider Name (Legal Business Name) : C.M. RYAN NURSE PRACTITIONER ADULT HEALTH, PLLC
Provider Business Mailing Address
First Line : 8 VALLEY FORGE DR
Second Line :
City : WHEATLEY HEIGHTS
State : NY
Zip : 11798-1215
Country : US
Telephone Number : 646-522-3502
Fax Number :
Provider Business Practice Location Address
First Line : 8 VALLEY FORGE DR
Second Line :
City : WHEATLEY HEIGHTS
State : NY
Zip : 11798-1215
Country : US
Telephone Number : 646-522-3502
Fax Number :
Authorized Official
Title or Position : ANP
Name : MRS. CLAUDETTE MINTO RYAN
Credential : ANP
Telephone Number : 646-522-3502
Provider Enumeration Date : 12/12/2011
Last Update Date : 12/12/2011

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