Provider Demographics
NPI:1780646489
Name:RYAN, STEPHANIE ELLEN (NP, CDE)
Entity Type:Individual
Prefix:MS
First Name:STEPHANIE
Middle Name:ELLEN
Last Name:RYAN
Suffix:
Gender:F
Credentials:NP, CDE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7166 WATERMAN AVE
Mailing Address - Street 2:
Mailing Address - City:UNIVERSITY CITY
Mailing Address - State:MO
Mailing Address - Zip Code:63130-4325
Mailing Address - Country:US
Mailing Address - Phone:314-652-4100
Mailing Address - Fax:314-289-6478
Practice Address - Street 1:7166 WATERMAN AVE
Practice Address - Street 2:
Practice Address - City:UNIVERSITY CITY
Practice Address - State:MO
Practice Address - Zip Code:63130-4325
Practice Address - Country:US
Practice Address - Phone:314-652-4100
Practice Address - Fax:314-289-6478
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care