Provider Demographics
NPI:1841570231
Name:RYAN, LIZBETH A (DOM)
Entity Type:Individual
Prefix:
First Name:LIZBETH
Middle Name:A
Last Name:RYAN
Suffix:
Gender:F
Credentials:DOM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5212 VILLAGE PKWY
Mailing Address - Street 2:STE. 8
Mailing Address - City:ROGERS
Mailing Address - State:AR
Mailing Address - Zip Code:72758-8104
Mailing Address - Country:US
Mailing Address - Phone:479-464-4000
Mailing Address - Fax:
Practice Address - Street 1:5212 VILLAGE PKWY
Practice Address - Street 2:STE. 8
Practice Address - City:ROGERS
Practice Address - State:AR
Practice Address - Zip Code:72758-8104
Practice Address - Country:US
Practice Address - Phone:479-464-4000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-17
Last Update Date:2011-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARAR LAC020171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist