Provider Demographics
NPI:1144316662
Name:RYAN, MICHELLE L (FNP)
Entity type:Individual
Prefix:MRS
First Name:MICHELLE
Middle Name:L
Last Name:RYAN
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:MISS
Other - First Name:MICHELLE
Other - Middle Name:LYNN
Other - Last Name:LEMBKE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:PO BOX 569
Mailing Address - Street 2:848 ROUTE 50
Mailing Address - City:BURNT HILLS
Mailing Address - State:NY
Mailing Address - Zip Code:12027-0569
Mailing Address - Country:US
Mailing Address - Phone:518-831-1500
Mailing Address - Fax:518-377-1677
Practice Address - Street 1:2554 STATE ROUTE 9
Practice Address - Street 2:
Practice Address - City:BALLSTON SPA
Practice Address - State:NY
Practice Address - Zip Code:12020-6312
Practice Address - Country:US
Practice Address - Phone:518-899-5002
Practice Address - Fax:518-899-5840
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-04
Last Update Date:2023-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF333007363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY120114000027OtherFIDELIS CARE NY
NY02328518Medicaid
NY307847OtherSENIOR WHOLE HEALTH
NY2296458OtherGHI-PPO
NY661084OtherGHI-HMO
NY120114000027OtherFIDELIS CARE NY
NY307847OtherSENIOR WHOLE HEALTH
NY2296458OtherGHI-PPO
NYJ400033346Medicare PIN