Provider Demographics
NPI:1922076595
Name:RYAN, NOLAN PHILLIP (EMT-B)
Entity Type:Individual
Prefix:MR
First Name:NOLAN
Middle Name:PHILLIP
Last Name:RYAN
Suffix:
Gender:M
Credentials:EMT-B
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1115 NORTH AVE
Mailing Address - Street 2:
Mailing Address - City:BATAVIA
Mailing Address - State:IL
Mailing Address - Zip Code:60510-1142
Mailing Address - Country:US
Mailing Address - Phone:630-406-9444
Mailing Address - Fax:
Practice Address - Street 1:1115 NORTH AVE
Practice Address - Street 2:
Practice Address - City:BATAVIA
Practice Address - State:IL
Practice Address - Zip Code:60510-1142
Practice Address - Country:US
Practice Address - Phone:630-406-9444
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL146N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes146N00000XEmergency Medical Service ProvidersEmergency Medical Technician, Basic