Provider Demographics
NPI:1598088247
Name:RYDER, OXANA P (LMP)
Entity type:Individual
Prefix:MRS
First Name:OXANA
Middle Name:P
Last Name:RYDER
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:OXANA
Other - Middle Name:PETROVNA
Other - Last Name:RYDER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:10809 211TH AVENUE CT E
Mailing Address - Street 2:
Mailing Address - City:BONNEY LAKE
Mailing Address - State:WA
Mailing Address - Zip Code:98391-6656
Mailing Address - Country:US
Mailing Address - Phone:206-407-5602
Mailing Address - Fax:
Practice Address - Street 1:10809 211TH AVENUE CT E
Practice Address - Street 2:
Practice Address - City:BONNEY LAKE
Practice Address - State:WA
Practice Address - Zip Code:98391-6656
Practice Address - Country:US
Practice Address - Phone:206-407-5602
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-09
Last Update Date:2025-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA60129815174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist