Provider Demographics
NPI:1659441038
Name:RYAN, SUSAN F (RN, NPP)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:F
Last Name:RYAN
Suffix:
Gender:F
Credentials:RN, NPP
Other - Prefix:
Other - First Name:SUSAN
Other - Middle Name:MARY
Other - Last Name:FAVARO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:8 CARTER COURT
Mailing Address - Street 2:PO BOX 905
Mailing Address - City:DANNEMORA
Mailing Address - State:NY
Mailing Address - Zip Code:12929-0905
Mailing Address - Country:US
Mailing Address - Phone:518-492-7066
Mailing Address - Fax:
Practice Address - Street 1:209 PARK STREET
Practice Address - Street 2:CITIZEN ADVOCATES
Practice Address - City:MALONE
Practice Address - State:NY
Practice Address - Zip Code:12953
Practice Address - Country:US
Practice Address - Phone:518-483-3261
Practice Address - Fax:518-483-3383
Is Sole Proprietor?:No
Enumeration Date:2006-11-09
Last Update Date:2010-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY517230-1163W00000X
NY401323363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163W00000XNursing Service ProvidersRegistered Nurse