Provider Demographics
NPI:1902407596
Name:RYAN, MISHARI DENISE
Entity Type:Individual
Prefix:
First Name:MISHARI
Middle Name:DENISE
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 1:1190 RIVER VALLEY DR APT 4
Mailing Address - Street 2:
Mailing Address - City:FLINT
Mailing Address - State:MI
Mailing Address - Zip Code:48532-2960
Mailing Address - Country:US
Mailing Address - Phone:810-406-5219
Mailing Address - Fax:
Practice Address - Street 1:1190 RIVER VALLEY DR APT 4
Practice Address - Street 2:
Practice Address - City:FLINT
Practice Address - State:MI
Practice Address - Zip Code:48532-2960
Practice Address - Country:US
Practice Address - Phone:810-406-5219
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-02
Last Update Date:2020-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide