Provider Demographics
NPI:1972525095
Name:RYAN, JODI E (PA)
Entity Type:Individual
Prefix:
First Name:JODI
Middle Name:E
Last Name:RYAN
Suffix:
Gender:F
Credentials:PA
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Mailing Address - Street 1:13 INDUSTRIAL PARK RD
Mailing Address - Street 2:
Mailing Address - City:SACO
Mailing Address - State:ME
Mailing Address - Zip Code:04072-1804
Mailing Address - Country:US
Mailing Address - Phone:207-283-8800
Mailing Address - Fax:207-294-3662
Practice Address - Street 1:13 INDUSTRIAL PARK RD
Practice Address - Street 2:
Practice Address - City:SACO
Practice Address - State:ME
Practice Address - Zip Code:04072-1804
Practice Address - Country:US
Practice Address - Phone:207-283-8800
Practice Address - Fax:207-294-3562
Is Sole Proprietor?:No
Enumeration Date:2006-07-25
Last Update Date:2022-09-30
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MEPA 164363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant