1205033610 NPI number — MELISSA AUTUMN RYAN CST,CFA,RSA

Table of content: MELISSA AUTUMN RYAN CST,CFA,RSA (NPI 1205033610)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1205033610 NPI number — MELISSA AUTUMN RYAN CST,CFA,RSA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
RYAN
Provider First Name:
MELISSA
Provider Middle Name:
AUTUMN
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
CST,CFA,RSA
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:
1205033610
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
48W741 LENSCHOW RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HAMPSHIRE
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60140-8672
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
847-683-9113
Provider Business Mailing Address Fax Number:
847-683-9113

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
300 RANDALL RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GENEVA
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60134-4200
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
630-208-4050
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/29/2007

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: 363AS0400X , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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