Provider Demographics
NPI:1437916244
Name:STEPHENSON, RYAN WESLEY
Entity Type:Individual
Prefix:
First Name:RYAN
Middle Name:WESLEY
Last Name:STEPHENSON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3791 S LAKE MOUNTAIN DR
Mailing Address - Street 2:
Mailing Address - City:SARATOGA SPRINGS
Mailing Address - State:UT
Mailing Address - Zip Code:84045-3589
Mailing Address - Country:US
Mailing Address - Phone:801-673-3552
Mailing Address - Fax:
Practice Address - Street 1:3791 S LAKE MOUNTAIN DR
Practice Address - Street 2:
Practice Address - City:SARATOGA SPRINGS
Practice Address - State:UT
Practice Address - Zip Code:84045-3589
Practice Address - Country:US
Practice Address - Phone:801-673-3552
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-28
Last Update Date:2024-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program