Provider Demographics
NPI:1962831511
Name:RYAN, AMANDA LEIGH (APN)
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:LEIGH
Last Name:RYAN
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3155 62ND AVE
Mailing Address - Street 2:
Mailing Address - City:NEW WINDSOR
Mailing Address - State:IL
Mailing Address - Zip Code:61465-9361
Mailing Address - Country:US
Mailing Address - Phone:309-737-3758
Mailing Address - Fax:
Practice Address - Street 1:3426 N PORT DR STE 200
Practice Address - Street 2:
Practice Address - City:MUSCATINE
Practice Address - State:IA
Practice Address - Zip Code:52761-2242
Practice Address - Country:US
Practice Address - Phone:563-263-2724
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-11-04
Last Update Date:2025-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAH154347363L00000X
IL277.002465363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner