Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213ES0131X | Foot Surgery | SC003030L | PA |
NPI | 1386725372 |
---|---|
Provider Name | Patrice Anne Ryan |
First Address | Hellertown, PA 18055-1525 |
Second Address | Hellertown, PA 18055-1525 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 18/10/2006 |
Last Update Date | 17/04/2009 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
T29986 | (02) | PA |