Basic Information
| Provider Information | |||||||||
| NPI: | 1376793398 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MCCLENDON | ||||||||
| FirstName: | RYAN | ||||||||
| MiddleName: | S | ||||||||
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| Credential: | CRNA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1015 E IOWA ST | ||||||||
| Address2: | |||||||||
| City: | PRAIRIE DU CHIEN | ||||||||
| State: | WI | ||||||||
| PostalCode: | 538211812 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5732757310 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1000 LINCOLN CIR SE | ||||||||
| Address2: | |||||||||
| City: | ORANGE CITY | ||||||||
| State: | IA | ||||||||
| PostalCode: | 51041 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7127375225 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 09/26/2008 | ||||||||
| LastUpdateDate: | 10/14/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 10/14/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 367500000X | 209007110 | IL | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Anesthetist, Certified Registered | 367500000X | D140467 | IA | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Anesthetist, Certified Registered | 367500000X | 4033-33 | WI | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Anesthetist, Certified Registered |
No ID Information.