MEDICARE: RYAN HONOMICHL

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	363L00000X	Nurse Practitioner	312082	AZ

General Provider Information

NPI Number	:	1568292720
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RYAN HONOMICHL

Provider Business Mailing Address
First Line	:	22729 N 102ND AVE
Second Line	:
City	:	PEORIA
State	:	AZ
Zip	:	85383-2731
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3120 W CAREFREE HWY STE B15
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85086-3201
Country	:	US
Telephone Number	:	480-608-5138
Fax Number	:

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

Provider Enumeration Date	:	08/02/2024
Last Update Date	:	08/19/2024

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Directions to “ RYAN HONOMICHL ” Practice Location

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