Provider Demographics
NPI:1093759961
Name:RYAN-KRAUSE, PATRICIA ANNE (RN, MSN, CPN)
Entity Type:Individual
Prefix:
First Name:PATRICIA
Middle Name:ANNE
Last Name:RYAN-KRAUSE
Suffix:
Gender:F
Credentials:RN, MSN, CPN
Other - Prefix:
Other - First Name:PATRICIA
Other - Middle Name:ANNE
Other - Last Name:RYAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:305 GREAT OAK ROAD
Mailing Address - Street 2:
Mailing Address - City:ORANGE
Mailing Address - State:CT
Mailing Address - Zip Code:06477
Mailing Address - Country:US
Mailing Address - Phone:203-376-0744
Mailing Address - Fax:
Practice Address - Street 1:299 WASHINGTON AVE STE LL
Practice Address - Street 2:
Practice Address - City:HAMDEN
Practice Address - State:CT
Practice Address - Zip Code:06518-3039
Practice Address - Country:US
Practice Address - Phone:203-288-4288
Practice Address - Fax:855-414-4010
Is Sole Proprietor?:No
Enumeration Date:2006-06-15
Last Update Date:2021-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000412363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT004254299Medicaid