Provider Demographics
NPI:1902657570
Name:BLAD, RYAN RICHARD (FNP-C)
Entity Type:Individual
Prefix:
First Name:RYAN
Middle Name:RICHARD
Last Name:BLAD
Suffix:
Gender:M
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:882 N MAIN ST STE 2
Mailing Address - Street 2:
Mailing Address - City:RICHFIELD
Mailing Address - State:UT
Mailing Address - Zip Code:84701-1840
Mailing Address - Country:US
Mailing Address - Phone:435-287-2444
Mailing Address - Fax:435-287-2446
Practice Address - Street 1:882 N MAIN ST STE 2
Practice Address - Street 2:
Practice Address - City:RICHFIELD
Practice Address - State:UT
Practice Address - Zip Code:84701-1840
Practice Address - Country:US
Practice Address - Phone:435-287-2444
Practice Address - Fax:435-287-2446
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-01
Last Update Date:2024-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT8460926-4405363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary CareGroup - Single Specialty