Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LF0000X | Nurse Practitioner - Family Medicine | F336650-1 | NY |
NPI | 1003108747 |
---|---|
Provider Name | Ms. Mary Ellen Ryan |
First Address | Peekskill, NY 10566-4173 |
Second Address | Yonkers, NY 10701-1206 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/05/2011 |
Last Update Date | 13/05/2011 |