Doctor Name: | MS. VICTORIA ELEANOR RYAN |
NPI Number: | 1003980210 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | PA-C |
License Number: | PA-626 |
Business Practice Address: | 990 Cesar Chavez Ave Pocatello, ID - 832090001 |
Business Phone Number: | 2082822330 |
Business Fax Number: | |
Mailing Address: | 990 Cesar Chavez Ave, POCATELLO |
State: | ID |
Postal Code: | 832090001 |
Phone Number: | |
Fax Number: | |
NPI Enumeration Date: | 11/20/2006 |
NPI Last Update Date: | 09/10/2015 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 390200000X |
License Number: | PA-626 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | ID |
Taxonomy Type: | Student, Health Care |
Taxonomy Classification: | Student in an Organized Health Care Education/Training Program |
Taxonomy Specialization: | |
Taxonomy Definition: | An individual who is enrolled in an organized health care education/training program leading to a degree, certification, registration, and/or licensure to provide health care. |