Provider Demographics
NPI:1467630251
Name:RYAN, MAXIENE H (LPN)
Entity Type:Individual
Prefix:MS
First Name:MAXIENE
Middle Name:H
Last Name:RYAN
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:170 HWY 134 EAST
Mailing Address - Street 2:
Mailing Address - City:DALEVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:36322
Mailing Address - Country:US
Mailing Address - Phone:334-598-4892
Mailing Address - Fax:
Practice Address - Street 1:301 ANDREWS AVENUE
Practice Address - Street 2:
Practice Address - City:FORT RUCKER
Practice Address - State:AL
Practice Address - Zip Code:36362
Practice Address - Country:US
Practice Address - Phone:334-255-7894
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-02-05
Last Update Date:2008-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL2-019139164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse