Provider Demographics
NPI:1720787880
Name:DIDDICK, RYAN WILLIAM
Entity Type:Individual
Prefix:
First Name:RYAN
Middle Name:WILLIAM
Last Name:DIDDICK
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:227 PRESIDENT AVE
Mailing Address - Street 2:
Mailing Address - City:SHIPPENSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17257-8401
Mailing Address - Country:US
Mailing Address - Phone:570-687-7220
Mailing Address - Fax:
Practice Address - Street 1:227 PRESIDENT AVE
Practice Address - Street 2:
Practice Address - City:SHIPPENSBURG
Practice Address - State:PA
Practice Address - Zip Code:17257-8401
Practice Address - Country:US
Practice Address - Phone:570-687-7220
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-02-27
Last Update Date:2023-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP027176363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily