Provider Demographics
NPI:1871659318
Name:RYE, JO ANNE
Entity Type:Individual
Prefix:MRS
First Name:JO
Middle Name:ANNE
Last Name:RYE
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:PO BOX 131
Mailing Address - Street 2:698 N TEWKSBURG BLVD
Mailing Address - City:YOUNG
Mailing Address - State:AZ
Mailing Address - Zip Code:85554
Mailing Address - Country:US
Mailing Address - Phone:928-462-3253
Mailing Address - Fax:928-462-6644
Practice Address - Street 1:698 N TEWKSBURG BLVD
Practice Address - Street 2:
Practice Address - City:YOUNG
Practice Address - State:AZ
Practice Address - Zip Code:85554
Practice Address - Country:US
Practice Address - Phone:928-462-3253
Practice Address - Fax:928-462-6644
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-29
Last Update Date:2007-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ385HR2055X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes385HR2055XRespite Care FacilityRespite CareRespite Care, Mental Illness, Child