Provider Demographics
NPI:1720754922
Name:FEDERICO-PICCIONI, RYAN D (RNC)
Entity Type:Individual
Prefix:MRS
First Name:RYAN
Middle Name:D
Last Name:FEDERICO-PICCIONI
Suffix:
Gender:F
Credentials:RNC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30 HUNTER LN
Mailing Address - Street 2:
Mailing Address - City:CAMP HILL
Mailing Address - State:PA
Mailing Address - Zip Code:17011-2400
Mailing Address - Country:US
Mailing Address - Phone:800-748-3243
Mailing Address - Fax:
Practice Address - Street 1:903 SHEPPARD RD
Practice Address - Street 2:
Practice Address - City:VOORHEES
Practice Address - State:NJ
Practice Address - Zip Code:08043-4695
Practice Address - Country:US
Practice Address - Phone:856-772-2300
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-18
Last Update Date:2022-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NR15798400163W00000X
NJ26NJ01358700363LF0000X
PARN632050163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty
No163W00000XNursing Service ProvidersRegistered Nurse