Provider Demographics
NPI:1184284812
Name:RYAN, HEATHER ANNE
Entity type:Individual
Prefix:
First Name:HEATHER
Middle Name:ANNE
Last Name:RYAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:HEATHET
Other - Middle Name:ANNE
Other - Last Name:DANLEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DNP, PMHNP
Mailing Address - Street 1:2102 W MADISON ST
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85009-5213
Mailing Address - Country:US
Mailing Address - Phone:602-617-3349
Mailing Address - Fax:
Practice Address - Street 1:10799 N 90TH ST STE 100
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85260-6110
Practice Address - Country:US
Practice Address - Phone:480-804-0326
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-14
Last Update Date:2019-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ227594363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health