Provider Demographics
NPI:1346250966
Name:RYAN, DIANE P (FNP)
Entity Type:Individual
Prefix:
First Name:DIANE
Middle Name:P
Last Name:RYAN
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3435 BAILEY AVE
Mailing Address - Street 2:
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14215-1145
Mailing Address - Country:US
Mailing Address - Phone:716-835-2966
Mailing Address - Fax:716-834-3901
Practice Address - Street 1:3435 BAILEY AVE
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14215-1145
Practice Address - Country:US
Practice Address - Phone:716-835-2966
Practice Address - Fax:716-834-3901
Is Sole Proprietor?:No
Enumeration Date:2006-08-08
Last Update Date:2014-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF334222-1363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
161573456OtherCOMMERCIAL INSURANCES
NY00027603901OtherUNIVERA
NY02780798Medicaid
NY9512761OtherINDEPENDENT HEALTH
NY000560507006OtherBC/BS OF WNY
NYP88539Medicare UPIN
NY02780798Medicaid