Provider Demographics
NPI:1780666016
Name:RYAN, PENNY LEE (RNFA)
Entity Type:Individual
Prefix:MS
First Name:PENNY
Middle Name:LEE
Last Name:RYAN
Suffix:
Gender:F
Credentials:RNFA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6395 STEEP HOLLOW CIR
Mailing Address - Street 2:
Mailing Address - City:BRYAN
Mailing Address - State:TX
Mailing Address - Zip Code:77808-5127
Mailing Address - Country:US
Mailing Address - Phone:979-776-0045
Mailing Address - Fax:979-774-3440
Practice Address - Street 1:6395 STEEP HOLLOW CIR
Practice Address - Street 2:
Practice Address - City:BRYAN
Practice Address - State:TX
Practice Address - Zip Code:77808-5127
Practice Address - Country:US
Practice Address - Phone:979-776-0045
Practice Address - Fax:979-774-3440
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX253494163WG0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice