Basic Information
| Provider Information | |||||||||
| NPI: | 1043411374 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | RYALL | ||||||||
| FirstName: | KRISTINE | ||||||||
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| Credential: | APRN MSN FNPC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3400 DATA DR 1ST | ||||||||
| Address2: | |||||||||
| City: | RANCHO CORDOVA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 956707956 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9163792726 | ||||||||
| FaxNumber: | 9168537874 | ||||||||
| Practice Location | |||||||||
| Address1: | 17051 SIERRA LAKES PKWY | ||||||||
| Address2: | STE 101 | ||||||||
| City: | FONTANA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 923361274 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9094282040 | ||||||||
| FaxNumber: | 9094282191 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/31/2007 | ||||||||
| LastUpdateDate: | 10/27/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 10/27/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | NP9750 | CA | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
No ID Information.