Provider Demographics
NPI:1558540914
Name:RYAN, TERRI L (RD)
Entity Type:Individual
Prefix:MS
First Name:TERRI
Middle Name:L
Last Name:RYAN
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:75-6026 ALII DR APT 4203
Mailing Address - Street 2:
Mailing Address - City:KAILUA KONA
Mailing Address - State:HI
Mailing Address - Zip Code:96740-4319
Mailing Address - Country:US
Mailing Address - Phone:808-345-6919
Mailing Address - Fax:808-331-2313
Practice Address - Street 1:75-184 HUALALAI RD STE 203
Practice Address - Street 2:
Practice Address - City:KAILUA KONA
Practice Address - State:HI
Practice Address - Zip Code:96740-1719
Practice Address - Country:US
Practice Address - Phone:808-329-9211
Practice Address - Fax:808-329-0009
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-01
Last Update Date:2023-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
HIAV603ZOtherMEDICARE PTAN