Provider Demographics
NPI:1255349601
Name:RYAN, ELIZABETH (NP)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:
Last Name:RYAN
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:819 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14611-2334
Mailing Address - Country:US
Mailing Address - Phone:585-235-0360
Mailing Address - Fax:
Practice Address - Street 1:819 W MAIN ST
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14611-2334
Practice Address - Country:US
Practice Address - Phone:585-235-0360
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-03
Last Update Date:2015-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF380968363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02708730Medicaid
172562DLOtherPREFERRED CARE
NY000928029001OtherHEALTHNOW
7599207OtherGROUP HEALTH INCORP