MEDICARE: NANCY RYAN APNP

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	363LF0000X	Family Nurse Practitioner	629033	WI

Other Identifiers

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

General Provider Information

NPI Number	:	1780752832
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NANCY RYAN APNP

Provider Business Mailing Address
First Line	:	147 W ROCKWELL ST
Second Line	:
City	:	JEFFERSON
State	:	WI
Zip	:	53549-2048
Country	:	US
Telephone Number	:	920-674-6255
Fax Number	:	920-674-5288

Provider Business Practice Location Address
First Line	:	1225 REMMEL DR
Second Line	:
City	:	JOHNSON CREEK
State	:	WI
Zip	:	53094-8511
Country	:	US
Telephone Number	:	920-674-6255
Fax Number	:	920-674-5288

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

Provider Enumeration Date	:	11/30/2006
Last Update Date	:	01/04/2021

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