Provider Demographics
NPI:1326416892
Name:RYAN, DONAVAN MARQUE (LPN)
Entity Type:Individual
Prefix:
First Name:DONAVAN
Middle Name:MARQUE
Last Name:RYAN
Suffix:
Gender:M
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11551 EDISON ST NE
Mailing Address - Street 2:
Mailing Address - City:ALLIANCE
Mailing Address - State:OH
Mailing Address - Zip Code:44601-9613
Mailing Address - Country:US
Mailing Address - Phone:330-581-9730
Mailing Address - Fax:
Practice Address - Street 1:11551 EDISON ST NE
Practice Address - Street 2:
Practice Address - City:ALLIANCE
Practice Address - State:OH
Practice Address - Zip Code:44601-9613
Practice Address - Country:US
Practice Address - Phone:330-581-9730
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-09-14
Last Update Date:2016-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH155170164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse