1144316662 NPI number — MRS. MICHELLE L RYAN FNP

Table of content: MRS. MICHELLE L RYAN FNP (NPI 1144316662)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1144316662 NPI number — MRS. MICHELLE L RYAN FNP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
RYAN
Provider First Name:
MICHELLE
Provider Middle Name:
L
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
FNP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
LEMBKE
Provider Other First Name:
MICHELLE
Provider Other Middle Name:
LYNN
Provider Other Name Prefix Text:
MISS
Provider Other Name Suffix Text:
Provider Other Credential Text:
NP
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1144316662
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/17/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 569
Provider Second Line Business Mailing Address:
848 ROUTE 50
Provider Business Mailing Address City Name:
BURNT HILLS
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
12027-0569
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
518-831-1500
Provider Business Mailing Address Fax Number:
518-377-1677

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2554 STATE ROUTE 9
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BALLSTON SPA
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
12020-6312
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
518-899-5002
Provider Business Practice Location Address Fax Number:
518-899-5840
Provider Enumeration Date:
10/04/2006

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:  F333007 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 120114000027 . This is a "FIDELIS CARE NY" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 02328518 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 307847 . This is a "SENIOR WHOLE HEALTH" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 2296458 . This is a "GHI-PPO" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 661084 . This is a "GHI-HMO" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com