Provider Demographics
NPI:1679903983
Name:RYALLS, LYNDSIE CAROLYN (APRN)
Entity Type:Individual
Prefix:
First Name:LYNDSIE
Middle Name:CAROLYN
Last Name:RYALLS
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:40 BROADWAY
Mailing Address - Street 2:
Mailing Address - City:NORWICH
Mailing Address - State:CT
Mailing Address - Zip Code:06360-5702
Mailing Address - Country:US
Mailing Address - Phone:860-887-6536
Mailing Address - Fax:860-887-2784
Practice Address - Street 1:40 BROADWAY
Practice Address - Street 2:
Practice Address - City:NORWICH
Practice Address - State:CT
Practice Address - Zip Code:06360-5702
Practice Address - Country:US
Practice Address - Phone:860-887-6536
Practice Address - Fax:860-887-2784
Is Sole Proprietor?:No
Enumeration Date:2013-11-22
Last Update Date:2016-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT5609363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health