MEDICARE: RYAN PAYNTER R.N

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	26NR13818200	NJ

General Provider Information

NPI Number	:	1528513520
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RYAN PAYNTER R.N

Provider Business Mailing Address
First Line	:	114 BRIARCLIFF DR
Second Line	:
City	:	EGG HARBOR TOWNSHIP
State	:	NJ
Zip	:	08234-8206
Country	:	US
Telephone Number	:	609-377-0143
Fax Number	:

Provider Business Practice Location Address
First Line	:	114 BRIARCLIFF DR
Second Line	:
City	:	EGG HARBOR TOWNSHIP
State	:	NJ
Zip	:	08234-8206
Country	:	US
Telephone Number	:	609-377-0143
Fax Number	:

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

Provider Enumeration Date	:	08/19/2016
Last Update Date	:	08/19/2016

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