Provider Demographics
NPI:1215650833
Name:RYAN, TARA (MSN RN, NC-BC, CHSE,)
Entity type:Individual
Prefix:
First Name:TARA
Middle Name:
Last Name:RYAN
Suffix:
Gender:F
Credentials:MSN RN, NC-BC, CHSE,
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9350 PAN RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21234-1529
Mailing Address - Country:US
Mailing Address - Phone:724-448-5330
Mailing Address - Fax:
Practice Address - Street 1:9350 PAN RIDGE RD
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21234-1529
Practice Address - Country:US
Practice Address - Phone:724-448-5330
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-20
Last Update Date:2022-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDRN21636163WC1600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC1600XNursing Service ProvidersRegistered NurseContinuing Education/Staff Development