Provider Demographics
NPI:1942409495
Name:RYAN, DIANE M (RN)
Entity Type:Individual
Prefix:MS
First Name:DIANE
Middle Name:M
Last Name:RYAN
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:164 N FOSTERTOWN DR
Mailing Address - Street 2:
Mailing Address - City:NEWBURGH
Mailing Address - State:NY
Mailing Address - Zip Code:12550-8713
Mailing Address - Country:US
Mailing Address - Phone:845-565-5780
Mailing Address - Fax:
Practice Address - Street 1:164 N FOSTERTOWN DR
Practice Address - Street 2:
Practice Address - City:NEWBURGH
Practice Address - State:NY
Practice Address - Zip Code:12550-8713
Practice Address - Country:US
Practice Address - Phone:845-565-5780
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-15
Last Update Date:2007-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY507773163WP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0200XNursing Service ProvidersRegistered NursePediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02551715Medicaid