Provider Demographics
NPI:1710960604
Name:RYAN, JEAN M (RN, FNP-C)
Entity Type:Individual
Prefix:MISS
First Name:JEAN
Middle Name:M
Last Name:RYAN
Suffix:
Gender:F
Credentials:RN, FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1009
Mailing Address - Street 2:
Mailing Address - City:SOCORRO
Mailing Address - State:NM
Mailing Address - Zip Code:87801-1009
Mailing Address - Country:US
Mailing Address - Phone:575-838-4690
Mailing Address - Fax:575-838-2380
Practice Address - Street 1:1204 HIGHWAY 60 # 1009
Practice Address - Street 2:
Practice Address - City:SOCORRO
Practice Address - State:NM
Practice Address - Zip Code:87801-3914
Practice Address - Country:US
Practice Address - Phone:575-838-3690
Practice Address - Fax:575-838-4689
Is Sole Proprietor?:No
Enumeration Date:2005-11-23
Last Update Date:2013-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR081000105RN163WG0000X
OR200250125NP FNP-PP363LF0000X
WAAP60004124363LF0000X
NMR37016163W00000X
WARN00056320163W00000X
NMCNP00802363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice
No163W00000XNursing Service ProvidersRegistered Nurse