Provider Demographics
NPI:1225629082
Name:NETHERS, RYAN
Entity Type:Individual
Prefix:
First Name:RYAN
Middle Name:
Last Name:NETHERS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:825 JUNCTION WAY APT 318
Mailing Address - Street 2:
Mailing Address - City:GRANDVIEW HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:43212-2584
Mailing Address - Country:US
Mailing Address - Phone:740-957-4079
Mailing Address - Fax:
Practice Address - Street 1:825 JUNCTION WAY APT 318
Practice Address - Street 2:
Practice Address - City:GRANDVIEW HEIGHTS
Practice Address - State:OH
Practice Address - Zip Code:43212-2584
Practice Address - Country:US
Practice Address - Phone:740-957-4079
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-03
Last Update Date:2021-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH455967163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse