Provider Demographics
NPI:1609038736
Name:WILLEMS, RYAN (PA)
Entity Type:Individual
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First Name:RYAN
Middle Name:
Last Name:WILLEMS
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Gender:M
Credentials:PA
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Mailing Address - Street 1:1216 RYANS RD
Mailing Address - Street 2:SUITE 1
Mailing Address - City:WORTHINGTON
Mailing Address - State:MN
Mailing Address - Zip Code:56187-1722
Mailing Address - Country:US
Mailing Address - Phone:507-372-2921
Mailing Address - Fax:507-372-5789
Practice Address - Street 1:1216 RYANS RD
Practice Address - Street 2:SUITE 1
Practice Address - City:WORTHINGTON
Practice Address - State:MN
Practice Address - Zip Code:56187-1722
Practice Address - Country:US
Practice Address - Phone:507-372-2921
Practice Address - Fax:507-372-5789
Is Sole Proprietor?:No
Enumeration Date:2008-06-30
Last Update Date:2015-05-26
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical