Provider Demographics
NPI:1568960045
Name:GRATZER, RYAN (REGISTERED NURSE)
Entity Type:Individual
Prefix:
First Name:RYAN
Middle Name:
Last Name:GRATZER
Suffix:
Gender:M
Credentials:REGISTERED NURSE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:958 WADSWORTH RD
Mailing Address - Street 2:
Mailing Address - City:MEDINA
Mailing Address - State:OH
Mailing Address - Zip Code:44256-3210
Mailing Address - Country:US
Mailing Address - Phone:440-897-2635
Mailing Address - Fax:
Practice Address - Street 1:7311 MEADOWHAVEN DR
Practice Address - Street 2:
Practice Address - City:CHIPPEWA LAKE
Practice Address - State:OH
Practice Address - Zip Code:44215-9804
Practice Address - Country:US
Practice Address - Phone:330-321-7365
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-01-30
Last Update Date:2018-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN.446115163WM0705X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WM0705XNursing Service ProvidersRegistered NurseMedical-Surgical