Provider Demographics
NPI:1336938760
Name:STORES, RYAN TAYLOR (RN)
Entity type:Individual
Prefix:
First Name:RYAN
Middle Name:TAYLOR
Last Name:STORES
Suffix:
Gender:
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2211 PRETTY LAKE AVE UNIT 401
Mailing Address - Street 2:
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23518-1047
Mailing Address - Country:US
Mailing Address - Phone:757-672-8237
Mailing Address - Fax:
Practice Address - Street 1:2211 PRETTY LAKE AVE UNIT 401
Practice Address - Street 2:
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23518-1047
Practice Address - Country:US
Practice Address - Phone:757-672-8237
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-05-02
Last Update Date:2025-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant