Provider Demographics
NPI:1043725112
Name:RYAN, EMILY ELIZABETH RADFORD (DNP, FNP-C)
Entity type:Individual
Prefix:
First Name:EMILY
Middle Name:ELIZABETH RADFORD
Last Name:RYAN
Suffix:
Gender:F
Credentials:DNP, FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2706 ELLEN ST
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27705-2034
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:414 EAST MAIN STREET
Practice Address - Street 2:CLINIC 6
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27701
Practice Address - Country:US
Practice Address - Phone:919-560-7600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-12-11
Last Update Date:2020-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5010102363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily