Provider Demographics
NPI:1467415786
Name:RYAN, LISA NICOLE (MD)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:NICOLE
Last Name:RYAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:LISA
Other - Middle Name:JEAN
Other - Last Name:SCHEER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:1169 MOKUHANO ST # 102
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96825-3810
Mailing Address - Country:US
Mailing Address - Phone:808-489-2288
Mailing Address - Fax:
Practice Address - Street 1:1169 MOKUHANO ST # 102
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96825-3810
Practice Address - Country:US
Practice Address - Phone:808-489-2288
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-04-08
Last Update Date:2013-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI133272084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry