Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP0808X | Nurse Practitioner - Psychiatric/Mental Health | 226766 | MA |
NPI | 1033287172 |
---|---|
Provider Name | Mr. David Dane Ryer |
First Address | Fall River, MA 02720-5211 |
Second Address | Fall River, MA 02720-5211 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/11/2006 |
Last Update Date | 21/08/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
P15369 | (02) |