Provider Demographics
NPI:1891021028
Name:GARY, RYANELLE T (LPN)
Entity Type:Individual
Prefix:MRS
First Name:RYANELLE
Middle Name:T
Last Name:GARY
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:465 OLYMPIC AVE
Mailing Address - Street 2:
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14215-2740
Mailing Address - Country:US
Mailing Address - Phone:716-308-2645
Mailing Address - Fax:716-608-1328
Practice Address - Street 1:465 OLYMPIC AVE
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14215-2740
Practice Address - Country:US
Practice Address - Phone:716-308-2645
Practice Address - Fax:716-608-1328
Is Sole Proprietor?:No
Enumeration Date:2009-10-22
Last Update Date:2022-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY291556164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse