Provider Demographics
NPI:1841760766
Name:MCBRYDE, RAN (APN)
Entity type:Individual
Prefix:
First Name:RAN
Middle Name:
Last Name:MCBRYDE
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7801 N 177TH AVE
Mailing Address - Street 2:
Mailing Address - City:WADDELL
Mailing Address - State:AZ
Mailing Address - Zip Code:85355-9379
Mailing Address - Country:US
Mailing Address - Phone:602-980-7810
Mailing Address - Fax:
Practice Address - Street 1:21620 N 19TH AVE STE A6
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85027-2716
Practice Address - Country:US
Practice Address - Phone:480-589-2890
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-12-04
Last Update Date:2018-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ219040363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily