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NPI Code Detail

MEDICARE: MR. MARK KENNETH RYAN CRNP MSN

MEDICARE: MR. MARK KENNETH RYAN CRNP MSN
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
1367500000XCertified Registered Nurse AnesthetistAC000091MD
2363LF0000XFamily Nurse PractitionerAC000091MD
3363LF0000XFamily Nurse PractitionerLG-0000752DE

Other Identifiers

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

General Provider Information

NPI Number : 1669447637
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. MARK KENNETH RYAN CRNP MSN
Provider Business Mailing Address
First Line : 30549 SUSSEX HWY
Second Line :
City : LAUREL
State : DE
Zip : 19956-3891
Country : US
Telephone Number : 302-715-5214
Fax Number : 302-628-6855
Provider Business Practice Location Address
First Line : 30549 SUSSEX HWY
Second Line :
City : LAUREL
State : DE
Zip : 19956-3891
Country : US
Telephone Number : 302-715-5214
Fax Number : 302-628-6855
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/22/2006
Last Update Date : 02/29/2016

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