Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LF0000X | Nurse Practitioner - Family Medicine | 2012031594 | MO |
NPI | 1003168642 |
---|---|
Provider Name | Sean M Ryan |
First Address | Kansas City, MO 64130-2807 |
Second Address | Kansas City, MO 64130-2807 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/10/2012 |
Last Update Date | 08/08/2014 |