Provider Demographics
NPI:1376857888
Name:RYAN, BETH BOWERS (MS RN)
Entity Type:Individual
Prefix:
First Name:BETH
Middle Name:BOWERS
Last Name:RYAN
Suffix:
Gender:F
Credentials:MS RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:BOX 473
Mailing Address - Street 2:
Mailing Address - City:WELLS
Mailing Address - State:NY
Mailing Address - Zip Code:12190-0473
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:139 WHITE BIRCH LANE
Practice Address - Street 2:
Practice Address - City:INDIAN LAKE
Practice Address - State:NY
Practice Address - Zip Code:12842-0250
Practice Address - Country:US
Practice Address - Phone:518-648-6146
Practice Address - Fax:518-648-6143
Is Sole Proprietor?:No
Enumeration Date:2010-07-27
Last Update Date:2012-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY221215-1163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse