Provider Demographics
NPI:1609053131
Name:RYAN, TERESA JOYCE (RN)
Entity Type:Individual
Prefix:MRS
First Name:TERESA
Middle Name:JOYCE
Last Name:RYAN
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:88 WINDY RDG
Mailing Address - Street 2:
Mailing Address - City:ALKOL
Mailing Address - State:WV
Mailing Address - Zip Code:25501-9598
Mailing Address - Country:US
Mailing Address - Phone:304-524-5084
Mailing Address - Fax:
Practice Address - Street 1:10 MARLAND AVENUE
Practice Address - Street 2:
Practice Address - City:HAMLIN
Practice Address - State:WV
Practice Address - Zip Code:25523
Practice Address - Country:US
Practice Address - Phone:304-824-3033
Practice Address - Fax:304-824-7947
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-28
Last Update Date:2008-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV48934163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV9704046000Medicaid