Provider Demographics
NPI:1578546339
Name:RYAN, SUZANNE MARY (MSN, CNM, WHCNP)
Entity Type:Individual
Prefix:MRS
First Name:SUZANNE
Middle Name:MARY
Last Name:RYAN
Suffix:
Gender:F
Credentials:MSN, CNM, WHCNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19321 SANTA FE TRL
Mailing Address - Street 2:
Mailing Address - City:LEAVENWORTH
Mailing Address - State:KS
Mailing Address - Zip Code:66048-8440
Mailing Address - Country:US
Mailing Address - Phone:913-547-1495
Mailing Address - Fax:186-688-5969
Practice Address - Street 1:6115 NIEMAN RD
Practice Address - Street 2:
Practice Address - City:SHAWNEE
Practice Address - State:KS
Practice Address - Zip Code:66203-2939
Practice Address - Country:US
Practice Address - Phone:913-547-1495
Practice Address - Fax:186-688-5969
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-26
Last Update Date:2011-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1471743111163WP2201X
MO2000162927163WX0003X, 363LW0102X, 367A00000X
KS64060367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
No163WP2201XNursing Service ProvidersRegistered NurseAmbulatory Care
No163WX0003XNursing Service ProvidersRegistered NurseObstetric, Inpatient
No363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS200331250 BMedicaid
MO259263523Medicaid