Provider Demographics
NPI:1356616312
Name:RYAN, KATHY (RN)
Entity type:Individual
Prefix:
First Name:KATHY
Middle Name:
Last Name:RYAN
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8552 85TH ST
Mailing Address - Street 2:WOODHAVEN
Mailing Address - City:WOODHAVEN
Mailing Address - State:NY
Mailing Address - Zip Code:11421-1233
Mailing Address - Country:US
Mailing Address - Phone:718-850-4353
Mailing Address - Fax:
Practice Address - Street 1:8552 85TH ST
Practice Address - Street 2:WOODHAVEN
Practice Address - City:WOODHAVEN
Practice Address - State:NY
Practice Address - Zip Code:11421-1233
Practice Address - Country:US
Practice Address - Phone:718-850-4353
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-09
Last Update Date:2012-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY275364-1163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse