Provider Demographics
NPI:1649012949
Name:SKOWRON, RYAN MATHEW (FNP)
Entity type:Individual
Prefix:
First Name:RYAN
Middle Name:MATHEW
Last Name:SKOWRON
Suffix:
Gender:M
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1903 SUNSET AVE
Mailing Address - Street 2:
Mailing Address - City:UTICA
Mailing Address - State:NY
Mailing Address - Zip Code:13502-5649
Mailing Address - Country:US
Mailing Address - Phone:315-624-8150
Mailing Address - Fax:
Practice Address - Street 1:1903 SUNSET AVE
Practice Address - Street 2:
Practice Address - City:UTICA
Practice Address - State:NY
Practice Address - Zip Code:13502-5649
Practice Address - Country:US
Practice Address - Phone:315-624-8150
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-10
Last Update Date:2024-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY814721-01163W00000X
NYF354231-01363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163W00000XNursing Service ProvidersRegistered Nurse