Provider Demographics
NPI:1508344391
Name:MARECK, RYAN (DNP)
Entity Type:Individual
Prefix:
First Name:RYAN
Middle Name:
Last Name:MARECK
Suffix:
Gender:M
Credentials:DNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 W 1ST ST
Mailing Address - Street 2:
Mailing Address - City:PAYNESVILLE
Mailing Address - State:MN
Mailing Address - Zip Code:56362-1445
Mailing Address - Country:US
Mailing Address - Phone:320-243-3767
Mailing Address - Fax:
Practice Address - Street 1:130 1ST ST NE
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:MN
Practice Address - Zip Code:56368
Practice Address - Country:US
Practice Address - Phone:320-597-2122
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-02
Last Update Date:2022-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN6053363LF0000X
MN651118207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine