Provider Demographics
NPI:1780334136
Name:WEALTHER, RYAN HARRISON
Entity type:Individual
Prefix:
First Name:RYAN
Middle Name:HARRISON
Last Name:WEALTHER
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 1:1950 W. POLK STREET
Mailing Address - Street 2:4TH FLOOR-SUITE 4800
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60612-3763
Mailing Address - Country:US
Mailing Address - Phone:312-864-4478
Mailing Address - Fax:
Practice Address - Street 1:3601 4TH ST
Practice Address - Street 2:
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79430-4329
Practice Address - Country:US
Practice Address - Phone:806-743-2300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-03-28
Last Update Date:2024-07-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program