Provider Demographics
NPI:1194713826
Name:RYAN, SHARON PRISCILLA (CRNA)
Entity type:Individual
Prefix:MS
First Name:SHARON
Middle Name:PRISCILLA
Last Name:RYAN
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:S
Other - Middle Name:P
Other - Last Name:RYAN INC
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:3068 S LADD AVE
Mailing Address - Street 2:
Mailing Address - City:GOLDSBY
Mailing Address - State:OK
Mailing Address - Zip Code:73093-9218
Mailing Address - Country:US
Mailing Address - Phone:405-826-8695
Mailing Address - Fax:
Practice Address - Street 1:3068 S LADD AVE
Practice Address - Street 2:
Practice Address - City:GOLDSBY
Practice Address - State:OK
Practice Address - Zip Code:73093-9218
Practice Address - Country:US
Practice Address - Phone:405-826-8695
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-06
Last Update Date:2016-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKR0039774367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100782300BMedicaid
OK249327303Medicare ID - Type Unspecified