Provider Demographics
NPI:1760137806
Name:RYAN, MICHELLE PAIGE (ACN)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:PAIGE
Last Name:RYAN
Suffix:
Gender:F
Credentials:ACN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3944 RANCH ROAD 620 S STE 100
Mailing Address - Street 2:
Mailing Address - City:BEE CAVE
Mailing Address - State:TX
Mailing Address - Zip Code:78738-7000
Mailing Address - Country:US
Mailing Address - Phone:512-965-3912
Mailing Address - Fax:737-225-8927
Practice Address - Street 1:3944 RANCH ROAD 620 S STE 100
Practice Address - Street 2:
Practice Address - City:BEE CAVE
Practice Address - State:TX
Practice Address - Zip Code:78738-7000
Practice Address - Country:US
Practice Address - Phone:512-965-3912
Practice Address - Fax:737-225-8927
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-17
Last Update Date:2022-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX133N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133N00000XDietary & Nutritional Service ProvidersNutritionist