Provider Demographics
NPI:1497131825
Name:RYAN, QUINN ELENA (PA-C)
Entity Type:Individual
Prefix:
First Name:QUINN
Middle Name:ELENA
Last Name:RYAN
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:QUINN
Other - Middle Name:ELENA
Other - Last Name:PENDRED
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:4815 LIBERTY AVE STE 310
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15224-2156
Mailing Address - Country:US
Mailing Address - Phone:412-578-1116
Mailing Address - Fax:412-605-6396
Practice Address - Street 1:4815 LIBERTY AVE STE 310
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15224-2156
Practice Address - Country:US
Practice Address - Phone:412-578-1116
Practice Address - Fax:412-605-6396
Is Sole Proprietor?:No
Enumeration Date:2015-08-07
Last Update Date:2021-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA058824363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA13595654OtherCAQH
PA103214139Medicaid