Provider Demographics
NPI:1013044494
Name:RYAN, NATASHA (NMD)
Entity Type:Individual
Prefix:
First Name:NATASHA
Middle Name:
Last Name:RYAN
Suffix:
Gender:F
Credentials:NMD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:8412 E SHEA BLVD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85260-6664
Mailing Address - Country:US
Mailing Address - Phone:480-874-1515
Mailing Address - Fax:480-991-8395
Practice Address - Street 1:8412 E SHEA BLVD
Practice Address - Street 2:SUITE 101
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85260-6664
Practice Address - Country:US
Practice Address - Phone:480-874-1515
Practice Address - Fax:480-991-8395
Is Sole Proprietor?:No
Enumeration Date:2007-02-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AZ05-873207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine