Provider Demographics
NPI:1942362918
Name:RYAN, FREIDA DIANE (CPT, RD, LD)
Entity Type:Individual
Prefix:MS
First Name:FREIDA
Middle Name:DIANE
Last Name:RYAN
Suffix:
Gender:F
Credentials:CPT, RD, LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1650 COCHRANE CIR, ATTN CREDENTIALS OFFICE
Mailing Address - Street 2:EVANS ARMY COMMUNITY HOSPITAL USA MEDDAC
Mailing Address - City:FORT CARSON
Mailing Address - State:CO
Mailing Address - Zip Code:80913-4604
Mailing Address - Country:US
Mailing Address - Phone:719-526-7844
Mailing Address - Fax:719-526-7984
Practice Address - Street 1:1650 COCHRANE CIR
Practice Address - Street 2:USA MEDDAC, ATTN NUTRITION CARE DEPARTMENT
Practice Address - City:FORT CARSON
Practice Address - State:CO
Practice Address - Zip Code:80913-4604
Practice Address - Country:US
Practice Address - Phone:719-526-7844
Practice Address - Fax:719-526-7984
Is Sole Proprietor?:No
Enumeration Date:2006-12-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXDT05251133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered