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NPI Code Detail

MEDICARE: NICHOLAS RYAN

MEDICARE: NICHOLAS RYAN
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
1172V00000XCommunity Health Worker

General Provider Information

NPI Number : 1902513633
Entity Type Code : Individual
Provider Name (Legal Business Name) : NICHOLAS RYAN
Provider Business Mailing Address
First Line : 340 E 600 S
Second Line :
City : SAINT GEORGE
State : UT
Zip : 84770-3949
Country : US
Telephone Number : 435-705-7574
Fax Number :
Provider Business Practice Location Address
First Line : 340 E 600 S
Second Line :
City : SAINT GEORGE
State : UT
Zip : 84770-3949
Country : US
Telephone Number : 435-705-7574
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/02/2022
Last Update Date : 11/02/2022

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Directions to “ NICHOLAS RYAN ” Practice Location

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