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NPI Code Detail

MEDICARE: MS. KANDI KAY RYAN RN

MEDICARE: MS. KANDI KAY 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
1163W00000XRegistered Nurse117693-030WI

General Provider Information

NPI Number : 1760710768
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. KANDI KAY RYAN RN
Provider Business Mailing Address
First Line : S 2845 WHITE EAGLE ROAD
Second Line :
City : BARABOO
State : WI
Zip : 53913-9064
Country : US
Telephone Number : 608-355-1240
Fax Number : 608-356-7152
Provider Business Practice Location Address
First Line : S 2845 WHITE EAGLE ROAD
Second Line : HOUSE OF WELLNESS
City : BARABOO
State : WI
Zip : 53913-9064
Country : US
Telephone Number : 608-355-1240
Fax Number : 608-356-7152
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/02/2009
Last Update Date : 12/02/2009

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