MEDICARE: MS. JOYA RYAN APN/CNP

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	363L00000X	Nurse Practitioner	309000182	IL

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	:	1801898085
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. JOYA RYAN APN/CNP

Provider Business Mailing Address
First Line	:	2 W ADAMS ST
Second Line	:
City	:	SULLIVAN
State	:	IL
Zip	:	61951-1943
Country	:	US
Telephone Number	:	217-728-7353
Fax Number	:	217-728-2580

Provider Business Practice Location Address
First Line	:	2 W ADAMS ST
Second Line	:
City	:	SULLIVAN
State	:	IL
Zip	:	61951-1943
Country	:	US
Telephone Number	:	217-728-7353
Fax Number	:	217-728-2580

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

Provider Enumeration Date	:	06/01/2005
Last Update Date	:	06/25/2013

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