Provider Demographics
NPI:1801857206
Name:RYAN, MARY ELAINE (DNP)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:ELAINE
Last Name:RYAN
Suffix:
Gender:F
Credentials:DNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1004 CARONDELET DR STE 440
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64114-4845
Mailing Address - Country:US
Mailing Address - Phone:816-943-7777
Mailing Address - Fax:816-943-7778
Practice Address - Street 1:1004 CARONDELET DR STE 440
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64114-4845
Practice Address - Country:US
Practice Address - Phone:816-943-7777
Practice Address - Fax:816-943-7778
Is Sole Proprietor?:No
Enumeration Date:2006-03-28
Last Update Date:2021-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO082347363L00000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOS55533Medicare UPIN
MOM228363Medicare ID - Type UnspecifiedMEDICARE