Provider Demographics
NPI:1427865948
Name:RYAN, MICHAEL JOHN-PAUL (APRN)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:JOHN-PAUL
Last Name:RYAN
Suffix:
Gender:M
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1414 E 4500 S
Mailing Address - Street 2:
Mailing Address - City:MILLCREEK
Mailing Address - State:UT
Mailing Address - Zip Code:84117-4228
Mailing Address - Country:US
Mailing Address - Phone:385-299-0473
Mailing Address - Fax:
Practice Address - Street 1:1414 E 4500 S
Practice Address - Street 2:
Practice Address - City:MILLCREEK
Practice Address - State:UT
Practice Address - Zip Code:84117-4228
Practice Address - Country:US
Practice Address - Phone:385-299-0473
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-12-17
Last Update Date:2024-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT12933889-4405363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty