MEDICARE: MS. PENNY LEE RYAN RNFA

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	163WG0000X	General Practice Registered Nurse	253494	TX

General Provider Information

NPI Number	:	1780666016
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. PENNY LEE RYAN RNFA

Provider Business Mailing Address
First Line	:	6395 STEEP HOLLOW CIR
Second Line	:
City	:	BRYAN
State	:	TX
Zip	:	77808-5127
Country	:	US
Telephone Number	:	979-776-0045
Fax Number	:	979-774-3440

Provider Business Practice Location Address
First Line	:	6395 STEEP HOLLOW CIR
Second Line	:
City	:	BRYAN
State	:	TX
Zip	:	77808-5127
Country	:	US
Telephone Number	:	979-776-0045
Fax Number	:	979-774-3440

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

Provider Enumeration Date	:	11/14/2005
Last Update Date	:	07/08/2007

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