Provider Demographics
NPI:1548278211
Name:RYAN, JANET A (PA)
Entity type:Individual
Prefix:
First Name:JANET
Middle Name:A
Last Name:RYAN
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:JANET
Other - Middle Name:A
Other - Last Name:RYAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA
Mailing Address - Street 1:9621 RIDGETOP BLVD NW
Mailing Address - Street 2:
Mailing Address - City:SILVERDALE
Mailing Address - State:WA
Mailing Address - Zip Code:98383-8502
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:9398 RIDGETOP BLVD NW
Practice Address - Street 2:
Practice Address - City:SILVERDALE
Practice Address - State:WA
Practice Address - Zip Code:98383-8505
Practice Address - Country:US
Practice Address - Phone:360-782-3200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-04
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1080363A00000X
MI5601003059363A00000X
WAPA60546522363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA363A0000XMedicaid
WI025107650Medicare ID - Type Unspecified
MIS96306Medicare UPIN
MIM82740012Medicare PIN
MIN92580005Medicare ID - Type Unspecified
WA363A0000XMedicaid
MIN92580005Medicare ID - Type Unspecified