Provider Demographics
NPI:1851018931
Name:RYAN, BRIANA MICHELLE
Entity Type:Individual
Prefix:
First Name:BRIANA
Middle Name:MICHELLE
Last Name:RYAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1016 SUSAN RD
Mailing Address - Street 2:
Mailing Address - City:RAVENNA
Mailing Address - State:OH
Mailing Address - Zip Code:44266-3583
Mailing Address - Country:US
Mailing Address - Phone:330-931-1051
Mailing Address - Fax:
Practice Address - Street 1:1016 SUSAN RD
Practice Address - Street 2:
Practice Address - City:RAVENNA
Practice Address - State:OH
Practice Address - Zip Code:44266-3583
Practice Address - Country:US
Practice Address - Phone:330-931-1051
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-10-20
Last Update Date:2022-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376J00000XNursing Service Related ProvidersHomemaker
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH6705732Medicaid