Basic Information
| Provider Information | |||||||||
| NPI: | 1790428944 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | RYAN | ||||||||
| FirstName: | TONYA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5300 PATTERSON AVE SE | ||||||||
| Address2: | |||||||||
| City: | GRAND RAPIDS | ||||||||
| State: | MI | ||||||||
| PostalCode: | 495125663 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6162225601 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 5300 PATTERSON AVE SE | ||||||||
| Address2: | |||||||||
| City: | GRAND RAPIDS | ||||||||
| State: | MI | ||||||||
| PostalCode: | 495125663 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6162225601 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/15/2022 | ||||||||
| LastUpdateDate: | 04/15/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 04/15/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163W00000X | 4704340201 | MI | Y | Nursing Service Providers | Registered Nurse |
No ID Information.