Provider Demographics
NPI:1841576204
Name:RYAN, MISTI (RN, IBCLC)
Entity Type:Individual
Prefix:
First Name:MISTI
Middle Name:
Last Name:RYAN
Suffix:
Gender:F
Credentials:RN, IBCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2102 GOLDFINCH LN
Mailing Address - Street 2:
Mailing Address - City:LEAGUE CITY
Mailing Address - State:TX
Mailing Address - Zip Code:77573-3867
Mailing Address - Country:US
Mailing Address - Phone:281-316-6986
Mailing Address - Fax:
Practice Address - Street 1:2102 GOLDFINCH LN
Practice Address - Street 2:
Practice Address - City:LEAGUE CITY
Practice Address - State:TX
Practice Address - Zip Code:77573-3867
Practice Address - Country:US
Practice Address - Phone:713-496-2223
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-10-31
Last Update Date:2011-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX651189163WL0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WL0100XNursing Service ProvidersRegistered NurseLactation Consultant