Provider Demographics
NPI:1639538150
Name:MIND-BODY CONNECTION FOR ADULT HEALTH NP, PLLC
Entity Type:Organization
Organization Name:MIND-BODY CONNECTION FOR ADULT HEALTH NP, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR/PRACTITIONER
Authorized Official - Prefix:DR
Authorized Official - First Name:MAUREEN
Authorized Official - Middle Name:
Authorized Official - Last Name:RYAN
Authorized Official - Suffix:
Authorized Official - Credentials:DNP, NP-C
Authorized Official - Phone:716-704-5682
Mailing Address - Street 1:4511 HARLEM RD
Mailing Address - Street 2:
Mailing Address - City:AMHERST
Mailing Address - State:NY
Mailing Address - Zip Code:14226-3803
Mailing Address - Country:US
Mailing Address - Phone:716-704-5683
Mailing Address - Fax:
Practice Address - Street 1:4511 HARLEM RD
Practice Address - Street 2:
Practice Address - City:AMHERST
Practice Address - State:NY
Practice Address - Zip Code:14226-3803
Practice Address - Country:US
Practice Address - Phone:716-704-5683
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-02-11
Last Update Date:2016-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF300457-1363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult HealthGroup - Multi-Specialty