Provider Demographics
NPI:1093538951
Name:COON, RYAN NICHOLAS (ND)
Entity type:Individual
Prefix:DR
First Name:RYAN
Middle Name:NICHOLAS
Last Name:COON
Suffix:
Gender:M
Credentials:ND
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2325 E RIO SALADO PKWY APT 4056
Mailing Address - Street 2:
Mailing Address - City:TEMPE
Mailing Address - State:AZ
Mailing Address - Zip Code:85288-7487
Mailing Address - Country:US
Mailing Address - Phone:518-929-5311
Mailing Address - Fax:
Practice Address - Street 1:2325 E RIO SALADO PKWY APT 4056
Practice Address - Street 2:
Practice Address - City:TEMPE
Practice Address - State:AZ
Practice Address - Zip Code:85288-7487
Practice Address - Country:US
Practice Address - Phone:518-929-5311
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-11-07
Last Update Date:2024-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ24-1898175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath