Provider Demographics
NPI:1558855460
Name:RYAN, LAUIRE (AT)
Entity Type:Individual
Prefix:
First Name:LAUIRE
Middle Name:
Last Name:RYAN
Suffix:
Gender:F
Credentials:AT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:940 MONROE AVE NW UNIT 224
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49503-1458
Mailing Address - Country:US
Mailing Address - Phone:269-420-0064
Mailing Address - Fax:
Practice Address - Street 1:940 MONROE AVE NW UNIT 224
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49503-1458
Practice Address - Country:US
Practice Address - Phone:269-420-0064
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-15
Last Update Date:2018-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI225500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225500000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/Technologist