Provider Demographics
NPI:1003515370
Name:RYAN, REBECCA JO
Entity Type:Individual
Prefix:MRS
First Name:REBECCA
Middle Name:JO
Last Name:RYAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7281 W VERSAILLES RD
Mailing Address - Street 2:
Mailing Address - City:COVINGTON
Mailing Address - State:OH
Mailing Address - Zip Code:45318-8848
Mailing Address - Country:US
Mailing Address - Phone:937-606-4744
Mailing Address - Fax:
Practice Address - Street 1:7281 W VERSAILLES RD
Practice Address - Street 2:
Practice Address - City:COVINGTON
Practice Address - State:OH
Practice Address - Zip Code:45318-8848
Practice Address - Country:US
Practice Address - Phone:937-606-4744
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-27
Last Update Date:2023-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant
No347C00000XTransportation ServicesPrivate Vehicle