Provider Demographics
NPI:1316102049
Name:RYAN, LAURA ANN (PA-C)
Entity type:Individual
Prefix:MISS
First Name:LAURA
Middle Name:ANN
Last Name:RYAN
Suffix:
Gender:F
Credentials:PA-C
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Mailing Address - Street 1:1411 N BECKLEY AVE
Mailing Address - Street 2:PAVILION 3, STE 268
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75203-1259
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1411 N BECKLEY AVE
Practice Address - Street 2:PAVILION 3, STE 268
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75203-1259
Practice Address - Country:US
Practice Address - Phone:214-947-4400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-07-22
Last Update Date:2009-11-20
Deactivation Date:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant