Provider Demographics
NPI:1447954136
Name:MICHELLE RYAN FAMILY HEALTH NURSE PRACTITIONER, PLLC
Entity type:Organization
Organization Name:MICHELLE RYAN FAMILY HEALTH NURSE PRACTITIONER, PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:SOLE MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:RYAN
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:518-441-8128
Mailing Address - Street 1:2554 ROUTE 9
Mailing Address - Street 2:
Mailing Address - City:BALLSTON SPA
Mailing Address - State:NY
Mailing Address - Zip Code:12020-6312
Mailing Address - Country:US
Mailing Address - Phone:518-899-5002
Mailing Address - Fax:518-899-5840
Practice Address - Street 1:2554 ROUTE 9
Practice Address - Street 2:
Practice Address - City:BALLSTON SPA
Practice Address - State:NY
Practice Address - Zip Code:12020-6312
Practice Address - Country:US
Practice Address - Phone:518-899-5002
Practice Address - Fax:518-899-5840
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-03-28
Last Update Date:2023-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Single Specialty