Provider Demographics
NPI:1962756460
Name:RYAN, MONICA CLARE (PA-C)
Entity type:Individual
Prefix:MRS
First Name:MONICA
Middle Name:CLARE
Last Name:RYAN
Suffix:
Gender:
Credentials:PA-C
Other - Prefix:MS
Other - First Name:MONICA
Other - Middle Name:CLARE
Other - Last Name:KERSCHNER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:8701 WATERTOWN PLANK ROAD
Mailing Address - Street 2:DEPARTMENT OF UROLOGY
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53226-3548
Mailing Address - Country:US
Mailing Address - Phone:414-955-0856
Mailing Address - Fax:414-955-0122
Practice Address - Street 1:3200 PLEASANT VALLEY RD
Practice Address - Street 2:DEPARTMENT OF UROLOGY, UROLOGIC ONCOLOGY DIVISION
Practice Address - City:WEST BEND
Practice Address - State:WI
Practice Address - Zip Code:53095
Practice Address - Country:US
Practice Address - Phone:262-836-7200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-11-05
Last Update Date:2025-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY23016189363AS0400X
WI3409363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical