Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207QS0010X | Family Doctor - Sports Medicine | 54065 | MN |
NPI | 1306163571 |
---|---|
Provider Name | Dr. Maria Christine Ryan |
First Address | Minnetonka, MN 55345-3522 |
Second Address | Minnetonka, MN 55345-3522 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/04/2010 |
Last Update Date | 02/04/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1306163571 | (05) | MN |