Provider Demographics
NPI:1669191854
Name:GRIST, RYAN (NBC-HWC)
Entity type:Individual
Prefix:
First Name:RYAN
Middle Name:
Last Name:GRIST
Suffix:
Gender:M
Credentials:NBC-HWC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3805 COUNCIL CRST
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53711-2922
Mailing Address - Country:US
Mailing Address - Phone:608-212-4516
Mailing Address - Fax:
Practice Address - Street 1:3805 COUNCIL CRST
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53711-2922
Practice Address - Country:US
Practice Address - Phone:608-212-4516
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-23
Last Update Date:2022-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171400000XOther Service ProvidersHealth & Wellness Coach