1043411374 NPI number — KRISTINE RYALL APRN MSN FNPC

Table of content: KRISTINE RYALL APRN MSN FNPC (NPI 1043411374)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1043411374 NPI number — KRISTINE RYALL APRN MSN FNPC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
RYALL
Provider First Name:
KRISTINE
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
APRN MSN FNPC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1043411374
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/27/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3400 DATA DR 1ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
RANCHO CORDOVA
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
95670-7956
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
916-379-2726
Provider Business Mailing Address Fax Number:
916-853-7874

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
17051 SIERRA LAKES PKWY
Provider Second Line Business Practice Location Address:
STE 101
Provider Business Practice Location Address City Name:
FONTANA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92336-1274
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
909-428-2040
Provider Business Practice Location Address Fax Number:
909-428-2191
Provider Enumeration Date:
05/31/2007

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363LF0000X , with the licence number:  NP9750 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)