Provider Demographics
NPI:1821347733
Name:RYAN, JOHANNA SMOKOSKI (ND)
Entity Type:Individual
Prefix:DR
First Name:JOHANNA
Middle Name:SMOKOSKI
Last Name:RYAN
Suffix:
Gender:F
Credentials:ND
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11A HOSPITAL CT STE 6
Mailing Address - Street 2:
Mailing Address - City:BELLOWS FALLS
Mailing Address - State:VT
Mailing Address - Zip Code:05101-1588
Mailing Address - Country:US
Mailing Address - Phone:802-732-8428
Mailing Address - Fax:802-732-8475
Practice Address - Street 1:11A HOSPITAL CT STE 6
Practice Address - Street 2:
Practice Address - City:BELLOWS FALLS
Practice Address - State:VT
Practice Address - Zip Code:05101-1588
Practice Address - Country:US
Practice Address - Phone:802-376-1185
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-06
Last Update Date:2018-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WANT60253613175F00000X
VT099.0134036207Q00000X, 175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine