Provider Demographics
NPI:1447930094
Name:TEOPENGCO, RYAN JAY REMO (APRN)
Entity type:Individual
Prefix:MR
First Name:RYAN JAY
Middle Name:REMO
Last Name:TEOPENGCO
Suffix:
Gender:M
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:198 GREAT BROOK RD
Mailing Address - Street 2:
Mailing Address - City:GROTON
Mailing Address - State:CT
Mailing Address - Zip Code:06340-7701
Mailing Address - Country:US
Mailing Address - Phone:717-329-3591
Mailing Address - Fax:
Practice Address - Street 1:111 SALEM TPKE
Practice Address - Street 2:
Practice Address - City:NORWICH
Practice Address - State:CT
Practice Address - Zip Code:06360-7403
Practice Address - Country:US
Practice Address - Phone:860-886-0023
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-19
Last Update Date:2023-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT12118363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care