Basic Information
| Provider Information | |||||||||
| NPI: | 1508223504 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | KAUFFMAN | ||||||||
| FirstName: | RYAN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 17 PALLADIO DR | ||||||||
| Address2: | |||||||||
| City: | STAFFORD | ||||||||
| State: | VA | ||||||||
| PostalCode: | 225546582 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5748492610 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2300 OPITZ BLVD | ||||||||
| Address2: | |||||||||
| City: | WOODBRIDGE | ||||||||
| State: | VA | ||||||||
| PostalCode: | 221913311 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7035231000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 01/21/2016 | ||||||||
| LastUpdateDate: | 05/11/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 05/11/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 367500000X | 07430421 | NH | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Anesthetist, Certified Registered | 390200000X | RN64617 | ME | N | Student, Health Care | Student in an Organized Health Care Education/Training Program | 390200000X | 28202197A | IN | N | Student, Health Care | Student in an Organized Health Care Education/Training Program | 390200000X | RN2298862 | MA | N | Student, Health Care | Student in an Organized Health Care Education/Training Program | 390200000X | RN1039205 | DC | N | Student, Health Care | Student in an Organized Health Care Education/Training Program | 367500000X | 0024176424 | VA | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Anesthetist, Certified Registered |
No ID Information.