Provider Demographics
NPI:1235572611
Name:NUNN-RYAN, REBECCA ELAINE (ARNP)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:ELAINE
Last Name:NUNN-RYAN
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:MRS
Other - First Name:REBECCA
Other - Middle Name:ELAINE
Other - Last Name:NUNN-RYAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:ARNP
Mailing Address - Street 1:1030 S WILLOW CIR
Mailing Address - Street 2:
Mailing Address - City:WEST DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50266-3808
Mailing Address - Country:US
Mailing Address - Phone:515-327-0197
Mailing Address - Fax:
Practice Address - Street 1:315 W 3RD ST N
Practice Address - Street 2:
Practice Address - City:NEWTON
Practice Address - State:IA
Practice Address - Zip Code:50208-2015
Practice Address - Country:US
Practice Address - Phone:641-792-1639
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-04-16
Last Update Date:2013-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAA083716363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily