Provider Demographics
NPI:1073650305
Name:RYAN, TERESA ANN (NP)
Entity type:Individual
Prefix:
First Name:TERESA
Middle Name:ANN
Last Name:RYAN
Suffix:
Gender:
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9015 W UNION HILLS DR STE 107-559
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:AZ
Mailing Address - Zip Code:85382-3106
Mailing Address - Country:US
Mailing Address - Phone:928-569-3238
Mailing Address - Fax:480-900-8597
Practice Address - Street 1:9015 W UNION HILLS DR STE 107-559
Practice Address - Street 2:
Practice Address - City:PEORIA
Practice Address - State:AZ
Practice Address - Zip Code:85382-3106
Practice Address - Country:US
Practice Address - Phone:928-569-3238
Practice Address - Fax:480-900-8597
Is Sole Proprietor?:No
Enumeration Date:2007-01-30
Last Update Date:2025-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAP10753363LF0000X, 363LP0808X
CA95002231363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACB238046OtherMEDICARE