Provider Demographics
NPI:1366424038
Name:RYAN, MIRIAM BLOOMFIELD (CRNP)
Entity type:Individual
Prefix:
First Name:MIRIAM
Middle Name:BLOOMFIELD
Last Name:RYAN
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:685 GOOD DR
Mailing Address - Street 2:PO BOX 4125
Mailing Address - City:LANCASTER
Mailing Address - State:PA
Mailing Address - Zip Code:17601-2426
Mailing Address - Country:US
Mailing Address - Phone:717-295-3900
Mailing Address - Fax:717-391-2459
Practice Address - Street 1:685 GOOD DR
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:PA
Practice Address - Zip Code:17601-2426
Practice Address - Country:US
Practice Address - Phone:717-295-3900
Practice Address - Fax:717-735-8728
Is Sole Proprietor?:No
Enumeration Date:2005-11-17
Last Update Date:2011-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP005030B363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAP00362536OtherRAILROAD MEDICARE
PAP00362536OtherRAILROAD MEDICARE
PAS78803Medicare UPIN