Provider Demographics
NPI:1952659575
Name:RYAN, MICHELLE L (APN FNP-BC)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:L
Last Name:RYAN
Suffix:
Gender:F
Credentials:APN FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6 HOSPITAL PLAZA
Mailing Address - Street 2:
Mailing Address - City:CLARKSBURG
Mailing Address - State:WV
Mailing Address - Zip Code:26301
Mailing Address - Country:US
Mailing Address - Phone:304-623-5661
Mailing Address - Fax:304-623-4892
Practice Address - Street 1:6 HOSPITAL PLAZA
Practice Address - Street 2:
Practice Address - City:CLARKSBURG
Practice Address - State:WV
Practice Address - Zip Code:26301
Practice Address - Country:US
Practice Address - Phone:304-623-5661
Practice Address - Fax:304-623-4892
Is Sole Proprietor?:No
Enumeration Date:2012-08-29
Last Update Date:2017-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV75783363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily