Provider Demographics
NPI:1760261218
Name:LEW, RYAN (MSN-E, RN, FNP)
Entity Type:Individual
Prefix:
First Name:RYAN
Middle Name:
Last Name:LEW
Suffix:
Gender:M
Credentials:MSN-E, RN, FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1505 WILSON TER STE 250
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91206-4075
Mailing Address - Country:US
Mailing Address - Phone:818-246-7115
Mailing Address - Fax:877-366-1148
Practice Address - Street 1:1505 WILSON TER STE 250
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91206-4075
Practice Address - Country:US
Practice Address - Phone:818-246-7115
Practice Address - Fax:877-366-1148
Is Sole Proprietor?:No
Enumeration Date:2023-09-25
Last Update Date:2023-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95027008363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily