Provider Demographics
NPI:1669447637
Name:RYAN, MARK KENNETH (CRNP MSN)
Entity Type:Individual
Prefix:MR
First Name:MARK
Middle Name:KENNETH
Last Name:RYAN
Suffix:
Gender:M
Credentials:CRNP MSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30549 SUSSEX HWY
Mailing Address - Street 2:
Mailing Address - City:LAUREL
Mailing Address - State:DE
Mailing Address - Zip Code:19956-3891
Mailing Address - Country:US
Mailing Address - Phone:302-715-5214
Mailing Address - Fax:302-628-6855
Practice Address - Street 1:30549 SUSSEX HWY
Practice Address - Street 2:
Practice Address - City:LAUREL
Practice Address - State:DE
Practice Address - Zip Code:19956-3891
Practice Address - Country:US
Practice Address - Phone:302-715-5214
Practice Address - Fax:302-628-6855
Is Sole Proprietor?:No
Enumeration Date:2006-02-22
Last Update Date:2016-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDAC000091367500000X, 363LF0000X
DELG-0000752363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD403638700Medicaid
MD403638700Medicaid
MDK231P555Medicare PIN