Provider Demographics
NPI:1922632603
Name:RYAN, PAUL ANDREW (RN)
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:ANDREW
Last Name:RYAN
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:204 COUNTY HIGHWAY U W
Mailing Address - Street 2:
Mailing Address - City:NORWALK
Mailing Address - State:WI
Mailing Address - Zip Code:54648-8240
Mailing Address - Country:US
Mailing Address - Phone:608-462-3849
Mailing Address - Fax:
Practice Address - Street 1:331 S WATER ST
Practice Address - Street 2:
Practice Address - City:SPARTA
Practice Address - State:WI
Practice Address - Zip Code:54656-1726
Practice Address - Country:US
Practice Address - Phone:608-462-3849
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-03
Last Update Date:2020-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI250926-30163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse