Provider Demographics
NPI:1427631431
Name:RYAN, RACHEL ASHLEY (NP-C)
Entity type:Individual
Prefix:
First Name:RACHEL
Middle Name:ASHLEY
Last Name:RYAN
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3170 S ANNETT AVE
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83705-4206
Mailing Address - Country:US
Mailing Address - Phone:208-283-9376
Mailing Address - Fax:
Practice Address - Street 1:3909 E FAIRVIEW AVE STE 100
Practice Address - Street 2:
Practice Address - City:MERIDIAN
Practice Address - State:ID
Practice Address - Zip Code:83642-5809
Practice Address - Country:US
Practice Address - Phone:208-283-9376
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-29
Last Update Date:2021-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDF04210326363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner