Provider Demographics
NPI:1760710768
Name:RYAN, KANDI KAY (RN)
Entity Type:Individual
Prefix:MS
First Name:KANDI
Middle Name:KAY
Last Name:RYAN
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:S 2845 WHITE EAGLE ROAD
Mailing Address - Street 2:
Mailing Address - City:BARABOO
Mailing Address - State:WI
Mailing Address - Zip Code:53913-9064
Mailing Address - Country:US
Mailing Address - Phone:608-355-1240
Mailing Address - Fax:608-356-7152
Practice Address - Street 1:S 2845 WHITE EAGLE ROAD
Practice Address - Street 2:HOUSE OF WELLNESS
Practice Address - City:BARABOO
Practice Address - State:WI
Practice Address - Zip Code:53913-9064
Practice Address - Country:US
Practice Address - Phone:608-355-1240
Practice Address - Fax:608-356-7152
Is Sole Proprietor?:No
Enumeration Date:2009-12-02
Last Update Date:2009-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI117693-030163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse