Provider Demographics
NPI:1437722162
Name:VAN RYZIN, EMILY GRACE (FNP)
Entity Type:Individual
Prefix:
First Name:EMILY
Middle Name:GRACE
Last Name:VAN RYZIN
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:EMILY
Other - Middle Name:GRACE
Other - Last Name:STEENWYK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FNP
Mailing Address - Street 1:16322 MAGELLAN LN
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92647-3527
Mailing Address - Country:US
Mailing Address - Phone:714-458-2017
Mailing Address - Fax:
Practice Address - Street 1:16322 MAGELLAN LN
Practice Address - Street 2:
Practice Address - City:HUNTINGTON BEACH
Practice Address - State:CA
Practice Address - Zip Code:92647-3527
Practice Address - Country:US
Practice Address - Phone:714-458-2017
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-21
Last Update Date:2023-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95017533363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily