Provider Demographics
NPI:1801898085
Name:RYAN, JOYA (APN/CNP)
Entity type:Individual
Prefix:MS
First Name:JOYA
Middle Name:
Last Name:RYAN
Suffix:
Gender:F
Credentials:APN/CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 W ADAMS ST
Mailing Address - Street 2:
Mailing Address - City:SULLIVAN
Mailing Address - State:IL
Mailing Address - Zip Code:61951-1943
Mailing Address - Country:US
Mailing Address - Phone:217-728-7353
Mailing Address - Fax:217-728-2580
Practice Address - Street 1:2 W ADAMS ST
Practice Address - Street 2:
Practice Address - City:SULLIVAN
Practice Address - State:IL
Practice Address - Zip Code:61951-1943
Practice Address - Country:US
Practice Address - Phone:217-728-7353
Practice Address - Fax:217-728-2580
Is Sole Proprietor?:No
Enumeration Date:2005-06-01
Last Update Date:2013-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL309000182363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL0360710252Medicaid
ILP49274Medicare UPIN
IL200695Medicare ID - Type Unspecified