Basic Information
Provider Information
NPI: 1609185800
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: HARP
FirstName: RYAN
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential: CRNA
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 1447 N HARRISON ST
Address2:  
City: SAGINAW
State: MI
PostalCode: 486024727
CountryCode: US
TelephoneNumber: 9895836237
FaxNumber: 9895836032
Practice Location
Address1: 1447 N HARRISON ST
Address2:  
City: SAGINAW
State: MI
PostalCode: 486024727
CountryCode: US
TelephoneNumber: 9895836237
FaxNumber: 9895836032
Other Information
ProviderEnumerationDate: 10/05/2010
LastUpdateDate: 07/23/2014
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
367500000X4704246083MIY Physician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered 

No ID Information.


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