Basic Information
| Provider Information | |||||||||
| NPI: | 1093166233 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | RYAN | ||||||||
| FirstName: | ALANA | ||||||||
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| Credential: | DO | ||||||||
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| Mailing Information | |||||||||
| Address1: | 205 N EAST AVE | ||||||||
| Address2: | |||||||||
| City: | JACKSON | ||||||||
| State: | MI | ||||||||
| PostalCode: | 492011753 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5177884800 | ||||||||
| FaxNumber: | 5178177050 | ||||||||
| Practice Location | |||||||||
| Address1: | 4951 W 18TH ST | ||||||||
| Address2: | |||||||||
| City: | LAWRENCE | ||||||||
| State: | KS | ||||||||
| PostalCode: | 660472090 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7858416540 | ||||||||
| FaxNumber: | 7858413129 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/29/2016 | ||||||||
| LastUpdateDate: | 06/04/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 06/04/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | R-10917 | IA | N | Allopathic & Osteopathic Physicians | Family Medicine | 207Q00000X | DO-05200 | IA | N | Allopathic & Osteopathic Physicians | Family Medicine | 390200000X | MI | N | Student, Health Care | Student in an Organized Health Care Education/Training Program | 207Q00000X | 0543253 | KS | Y | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.