Provider Demographics
NPI:1700923976
Name:RYAN, LAURA JEAN (CRNP)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:JEAN
Last Name:RYAN
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:836 PINE DR
Mailing Address - Street 2:
Mailing Address - City:RIDGWAY
Mailing Address - State:CO
Mailing Address - Zip Code:81432-9494
Mailing Address - Country:US
Mailing Address - Phone:301-236-4322
Mailing Address - Fax:
Practice Address - Street 1:500 WEST PACIFIC AVENUE
Practice Address - Street 2:
Practice Address - City:TELLURIDE
Practice Address - State:CO
Practice Address - Zip Code:81435-1229
Practice Address - Country:US
Practice Address - Phone:970-424-1673
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-30
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR109434363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDMR0318457OtherDEA