Provider Demographics
NPI:1720321821
Name:DOYLE, RYAN J (LPN)
Entity Type:Individual
Prefix:MR
First Name:RYAN
Middle Name:J
Last Name:DOYLE
Suffix:
Gender:M
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:274 N COUNTRY RD
Mailing Address - Street 2:
Mailing Address - City:WADING RIVER
Mailing Address - State:NY
Mailing Address - Zip Code:11792-9302
Mailing Address - Country:US
Mailing Address - Phone:631-767-8167
Mailing Address - Fax:
Practice Address - Street 1:274 N COUNTRY RD
Practice Address - Street 2:
Practice Address - City:WADING RIVER
Practice Address - State:NY
Practice Address - Zip Code:11792-9302
Practice Address - Country:US
Practice Address - Phone:631-767-8167
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-27
Last Update Date:2013-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY313806164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse