Provider Demographics
NPI:1528012572
Name:RYAN, COLLEEN (RN)
Entity Type:Individual
Prefix:
First Name:COLLEEN
Middle Name:
Last Name:RYAN
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9121 WATERSIDE ST
Mailing Address - Street 2:#211
Mailing Address - City:MIDDLETON
Mailing Address - State:WI
Mailing Address - Zip Code:53562-5042
Mailing Address - Country:US
Mailing Address - Phone:608-821-0556
Mailing Address - Fax:
Practice Address - Street 1:201 S PARK ST
Practice Address - Street 2:#20
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53715-1573
Practice Address - Country:US
Practice Address - Phone:608-251-8426
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-22
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI38338400Medicaid