Provider Demographics
NPI:1265977185
Name:RYAN, G. ALICIA ALICIA (RN, MSN)
Entity type:Individual
Prefix:
First Name:G. ALICIA
Middle Name:ALICIA
Last Name:RYAN
Suffix:
Gender:F
Credentials:RN, MSN
Other - Prefix:
Other - First Name:GLORIA
Other - Middle Name:ALICIA
Other - Last Name:RYAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:5961 W PARKER RD APT 1318
Mailing Address - Street 2:
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75093-7751
Mailing Address - Country:US
Mailing Address - Phone:859-496-6118
Mailing Address - Fax:
Practice Address - Street 1:5961 W PARKER RD APT 1318
Practice Address - Street 2:
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75093-7751
Practice Address - Country:US
Practice Address - Phone:859-496-6118
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-01-02
Last Update Date:2017-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX906095171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator