Provider Demographics
NPI:1013161181
Name:SWEENEY, RYAN LEE (NMD)
Entity type:Individual
Prefix:DR
First Name:RYAN
Middle Name:LEE
Last Name:SWEENEY
Suffix:
Gender:M
Credentials:NMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:624 N HUMPHREY'S
Mailing Address - Street 2:SUITE #2
Mailing Address - City:FLAGSTAFF
Mailing Address - State:AZ
Mailing Address - Zip Code:86001
Mailing Address - Country:US
Mailing Address - Phone:928-637-6795
Mailing Address - Fax:928-637-6796
Practice Address - Street 1:5110 SE DIVISION ST
Practice Address - Street 2:APT #2
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97206-1408
Practice Address - Country:US
Practice Address - Phone:503-984-2145
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-15
Last Update Date:2011-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR1650175F00000X
AZ11-1231175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath