Provider Demographics
NPI:1639769722
Name:RYON, DORA LYNN
Entity Type:Individual
Prefix:
First Name:DORA
Middle Name:LYNN
Last Name:RYON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:135 HANNAS RD
Mailing Address - Street 2:
Mailing Address - City:ROMNEY
Mailing Address - State:WV
Mailing Address - Zip Code:26757-6274
Mailing Address - Country:US
Mailing Address - Phone:304-240-4613
Mailing Address - Fax:
Practice Address - Street 1:135 HANNAS RD
Practice Address - Street 2:
Practice Address - City:ROMNEY
Practice Address - State:WV
Practice Address - Zip Code:26757-6274
Practice Address - Country:US
Practice Address - Phone:304-240-4613
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-01-22
Last Update Date:2021-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant