Provider Demographics
NPI:1447376132
Name:RYAN, MONICA C (DNP, APN-BC)
Entity type:Individual
Prefix:
First Name:MONICA
Middle Name:C
Last Name:RYAN
Suffix:
Gender:F
Credentials:DNP, APN-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15427 THISTLEWOOD DR
Mailing Address - Street 2:
Mailing Address - City:ORLAND PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60462-3808
Mailing Address - Country:US
Mailing Address - Phone:708-349-0695
Mailing Address - Fax:
Practice Address - Street 1:10961 S KEDZIE AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60655-2219
Practice Address - Country:US
Practice Address - Phone:773-239-9100
Practice Address - Fax:773-239-9102
Is Sole Proprietor?:No
Enumeration Date:2007-03-22
Last Update Date:2015-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209-001874363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily