Provider Demographics
NPI:1003295981
Name:MAURER, RYAN C
Entity type:Individual
Prefix:
First Name:RYAN
Middle Name:C
Last Name:MAURER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:S3712 WOODLAND RD
Mailing Address - Street 2:
Mailing Address - City:VIROQUA
Mailing Address - State:WI
Mailing Address - Zip Code:54665-8153
Mailing Address - Country:US
Mailing Address - Phone:262-977-4052
Mailing Address - Fax:
Practice Address - Street 1:S3712 WOODLAND RD
Practice Address - Street 2:
Practice Address - City:VIROQUA
Practice Address - State:WI
Practice Address - Zip Code:54665-8153
Practice Address - Country:US
Practice Address - Phone:262-977-4052
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-05-25
Last Update Date:2015-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI0809M50494OtherMEDI SHARE