1538965009 NPI number — EDITH JOHANNA RYAN JOHANNA

Table of content: EDITH JOHANNA RYAN JOHANNA (NPI 1538965009)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1538965009 NPI number — EDITH JOHANNA RYAN JOHANNA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
RYAN
Provider First Name:
EDITH
Provider Middle Name:
JOHANNA
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
JOHANNA
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
WILLIS
Provider Other First Name:
WENTZ
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1538965009
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/24/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4506 N 49TH
Provider Second Line Business Mailing Address:
APT 10
Provider Business Mailing Address City Name:
OMAHA
Provider Business Mailing Address State Name:
NE
Provider Business Mailing Address Postal Code:
68104
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
531-272-2313
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1820 HILLCREST DRIVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BELLEVUE
Provider Business Practice Location Address State Name:
NE
Provider Business Practice Location Address Postal Code:
68005
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
402-682-6599
Provider Business Practice Location Address Fax Number:
402-682-6563
Provider Enumeration Date:
02/24/2025

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: 3747P1801X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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