Provider Demographics
NPI:1629596945
Name:RYFA, STACYANN HOUGH (FNP-C)
Entity Type:Individual
Prefix:MRS
First Name:STACYANN
Middle Name:HOUGH
Last Name:RYFA
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:MS
Other - First Name:STACYANN
Other - Middle Name:SJOSTEDT
Other - Last Name:HOUGH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:62 SOUTH ST UNIT 3
Mailing Address - Street 2:
Mailing Address - City:QUINCY
Mailing Address - State:MA
Mailing Address - Zip Code:02169-6835
Mailing Address - Country:US
Mailing Address - Phone:857-919-0079
Mailing Address - Fax:
Practice Address - Street 1:2100 DORCHESTER AVE
Practice Address - Street 2:
Practice Address - City:DORCHESTER
Practice Address - State:MA
Practice Address - Zip Code:02124-5615
Practice Address - Country:US
Practice Address - Phone:617-506-2273
Practice Address - Fax:617-474-3860
Is Sole Proprietor?:No
Enumeration Date:2017-09-07
Last Update Date:2017-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN2307301363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily