MEDICARE: KASSANDRA RYAN RN

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	R1847039	MN

General Provider Information

NPI Number	:	1679444848
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KASSANDRA RYAN RN

Provider Business Mailing Address
First Line	:	8314 ARROWWOOD LN N
Second Line	:
City	:	MAPLE GROVE
State	:	MN
Zip	:	55369-7600
Country	:	US
Telephone Number	:	320-420-8367
Fax Number	:

Provider Business Practice Location Address
First Line	:	8314 ARROWWOOD LN N
Second Line	:
City	:	MAPLE GROVE
State	:	MN
Zip	:	55369-7600
Country	:	US
Telephone Number	:	320-420-8367
Fax Number	:

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

Provider Enumeration Date	:	09/12/2025
Last Update Date	:	09/12/2025

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