Provider Demographics
NPI:1497009062
Name:RYAN, STEFANIE ANNE (APN)
Entity Type:Individual
Prefix:
First Name:STEFANIE
Middle Name:ANNE
Last Name:RYAN
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1200 W WALNUT ST
Mailing Address - Street 2:SUITE 2200
Mailing Address - City:ROGERS
Mailing Address - State:AR
Mailing Address - Zip Code:72756-3521
Mailing Address - Country:US
Mailing Address - Phone:479-986-1300
Mailing Address - Fax:
Practice Address - Street 1:1200 W WALNUT ST
Practice Address - Street 2:SUITE 2200
Practice Address - City:ROGERS
Practice Address - State:AR
Practice Address - Zip Code:72756-3521
Practice Address - Country:US
Practice Address - Phone:479-986-1300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-11-05
Last Update Date:2012-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARATP000499363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health