Provider Demographics
NPI:1952472367
Name:RYAN, JOANNE (NP)
Entity Type:Individual
Prefix:
First Name:JOANNE
Middle Name:
Last Name:RYAN
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 PANTIGO PLACE
Mailing Address - Street 2:SUITE I
Mailing Address - City:EAST HAMPTON
Mailing Address - State:NY
Mailing Address - Zip Code:11937
Mailing Address - Country:US
Mailing Address - Phone:631-329-8430
Mailing Address - Fax:631-329-8291
Practice Address - Street 1:200 PANTIGO PLACE
Practice Address - Street 2:SUITE I
Practice Address - City:EAST HAMPTON
Practice Address - State:NY
Practice Address - Zip Code:11937
Practice Address - Country:US
Practice Address - Phone:631-329-8430
Practice Address - Fax:631-329-8291
Is Sole Proprietor?:No
Enumeration Date:2006-11-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF3329631363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily