Provider Demographics
NPI:1710219423
Name:RYAN, KRISTINA A (MAC,LAC)
Entity Type:Individual
Prefix:
First Name:KRISTINA
Middle Name:A
Last Name:RYAN
Suffix:
Gender:F
Credentials:MAC,LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 SWEET BAY LN
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:MA
Mailing Address - Zip Code:01773-4705
Mailing Address - Country:US
Mailing Address - Phone:781-259-8440
Mailing Address - Fax:781-259-8466
Practice Address - Street 1:1719 MASSACHUSETTS AVE
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:MA
Practice Address - Zip Code:02420-5306
Practice Address - Country:US
Practice Address - Phone:781-910-5927
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-02-04
Last Update Date:2010-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA235319171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist