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NPI Code Detail

MEDICARE: RYAN C UPSON NP

MEDICARE: RYAN C UPSON NP
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
1363LP0808XPsychiatric/Mental Health Nurse Practitioner4704234352MI

General Provider Information

NPI Number : 1891032439
Entity Type Code : Individual
Provider Name (Legal Business Name) : RYAN C UPSON NP
Provider Business Mailing Address
First Line : 812 E JOLLY RD
Second Line : SUITE 210
City : LANSING
State : MI
Zip : 48910-6818
Country : US
Telephone Number : 514-346-8000
Fax Number : 514-346-8291
Provider Business Practice Location Address
First Line : 3475 BELLE CHASE WAY
Second Line :
City : LANSING
State : MI
Zip : 48911-4252
Country : US
Telephone Number : 517-882-3732
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/15/2013
Last Update Date : 03/04/2020

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Directions to “ RYAN C UPSON NP” Practice Location

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