Provider Demographics
NPI:1114739950
Name:TAKENS, RYAN
Entity type:Individual
Prefix:
First Name:RYAN
Middle Name:
Last Name:TAKENS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6088 SUNNINGDALE DR
Mailing Address - Street 2:
Mailing Address - City:HUDSONVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:49426-8962
Mailing Address - Country:US
Mailing Address - Phone:616-706-5948
Mailing Address - Fax:
Practice Address - Street 1:6088 SUNNINGDALE DR
Practice Address - Street 2:
Practice Address - City:HUDSONVILLE
Practice Address - State:MI
Practice Address - Zip Code:49426-8962
Practice Address - Country:US
Practice Address - Phone:616-706-5948
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-20
Last Update Date:2025-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant