Provider Demographics
NPI:1013201102
Name:RYAN, TERESA MARIE (RN, BSN)
Entity Type:Individual
Prefix:
First Name:TERESA
Middle Name:MARIE
Last Name:RYAN
Suffix:
Gender:F
Credentials:RN, BSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8200 DODGE ST
Mailing Address - Street 2:CHILDREN'S HOSPITAL & MEDICAL CENTER
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68114-4113
Mailing Address - Country:US
Mailing Address - Phone:402-955-5400
Mailing Address - Fax:
Practice Address - Street 1:1000 N 90TH ST STE 300
Practice Address - Street 2:CHILDREN'S HOSPITAL & MEDICAL CENTER - EDP
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68114-2766
Practice Address - Country:US
Practice Address - Phone:402-955-6190
Practice Address - Fax:402-955-6195
Is Sole Proprietor?:No
Enumeration Date:2011-06-06
Last Update Date:2011-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE48567163WP0807X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0807XNursing Service ProvidersRegistered NursePsychiatric/Mental Health, Child & Adolescent