Provider Demographics
NPI:1093053993
Name:RYAN, CHRISSY MARIE (RN)
Entity Type:Individual
Prefix:MRS
First Name:CHRISSY
Middle Name:MARIE
Last Name:RYAN
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26 QUEEN ST 6TH FLOOR
Mailing Address - Street 2:FLOW PACT
Mailing Address - City:WORCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01610
Mailing Address - Country:US
Mailing Address - Phone:508-373-7939
Mailing Address - Fax:
Practice Address - Street 1:26 QUEEN ST 6TH FLOOR
Practice Address - Street 2:FLOW PACT
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01610
Practice Address - Country:US
Practice Address - Phone:508-373-7939
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-28
Last Update Date:2013-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN2278745163WP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health