Provider Demographics
NPI:1710221684
Name:WHITCOMB, RYAN (CRNP)
Entity Type:Individual
Prefix:
First Name:RYAN
Middle Name:
Last Name:WHITCOMB
Suffix:
Gender:M
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:920 LAWN AVE
Mailing Address - Street 2:STE 5
Mailing Address - City:SELLERSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:18960-1560
Mailing Address - Country:US
Mailing Address - Phone:215-257-4900
Mailing Address - Fax:215-257-6681
Practice Address - Street 1:920 LAWN AVE
Practice Address - Street 2:STE 5
Practice Address - City:SELLERSVILLE
Practice Address - State:PA
Practice Address - Zip Code:18960-1560
Practice Address - Country:US
Practice Address - Phone:215-257-4900
Practice Address - Fax:215-257-6681
Is Sole Proprietor?:No
Enumeration Date:2012-11-16
Last Update Date:2022-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP012513363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner