Provider Demographics
NPI:1669892774
Name:RYAN, MARCELLA
Entity type:Individual
Prefix:
First Name:MARCELLA
Middle Name:
Last Name:RYAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:MARCY
Other - Middle Name:
Other - Last Name:RYAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:16351 S MOORE RD
Mailing Address - Street 2:
Mailing Address - City:OREGON CITY
Mailing Address - State:OR
Mailing Address - Zip Code:97045-9318
Mailing Address - Country:US
Mailing Address - Phone:503-632-5227
Mailing Address - Fax:503-632-5497
Practice Address - Street 1:16351 S MOORE RD
Practice Address - Street 2:
Practice Address - City:OREGON CITY
Practice Address - State:OR
Practice Address - Zip Code:97045-9318
Practice Address - Country:US
Practice Address - Phone:503-632-5227
Practice Address - Fax:503-632-5497
Is Sole Proprietor?:No
Enumeration Date:2014-04-16
Last Update Date:2019-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider