Provider Demographics
NPI:1497554489
Name:RYAN, TAYLOR DAWN (MS, RDN, LDN)
Entity type:Individual
Prefix:
First Name:TAYLOR
Middle Name:DAWN
Last Name:RYAN
Suffix:
Gender:F
Credentials:MS, RDN, LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1734 E BOWSTRING ST
Mailing Address - Street 2:
Mailing Address - City:MERIDIAN
Mailing Address - State:ID
Mailing Address - Zip Code:83642-3564
Mailing Address - Country:US
Mailing Address - Phone:208-957-1605
Mailing Address - Fax:
Practice Address - Street 1:1734 E BOWSTRING ST
Practice Address - Street 2:
Practice Address - City:MERIDIAN
Practice Address - State:ID
Practice Address - Zip Code:83642-3564
Practice Address - Country:US
Practice Address - Phone:208-957-1605
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-11
Last Update Date:2025-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID1971040133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered