Provider Demographics
NPI:1811144371
Name:RYAN, HEATHER LEE (FNP-BC)
Entity type:Individual
Prefix:MRS
First Name:HEATHER
Middle Name:LEE
Last Name:RYAN
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:MS
Other - First Name:HEATHER
Other - Middle Name:LEE
Other - Last Name:BEANE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FNP-BC
Mailing Address - Street 1:485 N SHORE RD
Mailing Address - Street 2:
Mailing Address - City:HEBRON
Mailing Address - State:NH
Mailing Address - Zip Code:03241-7222
Mailing Address - Country:US
Mailing Address - Phone:617-785-0917
Mailing Address - Fax:
Practice Address - Street 1:9900 BREN RD E
Practice Address - Street 2:
Practice Address - City:MINNETONKA
Practice Address - State:MN
Practice Address - Zip Code:55343-9664
Practice Address - Country:US
Practice Address - Phone:617-785-0917
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-08-26
Last Update Date:2021-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA253759363LF0000X
CO0990001363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO1811144371OtherNPI
CO1811144371OtherNPI
MA000877101Medicare PIN