Provider Demographics
NPI:1588143606
Name:RYAN, DENA GOURLEY (FNP - BC)
Entity type:Individual
Prefix:
First Name:DENA
Middle Name:GOURLEY
Last Name:RYAN
Suffix:
Gender:F
Credentials:FNP - BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19 ANTONY RD
Mailing Address - Street 2:
Mailing Address - City:WHITE PLAINS
Mailing Address - State:NY
Mailing Address - Zip Code:10605-2905
Mailing Address - Country:US
Mailing Address - Phone:623-810-6554
Mailing Address - Fax:
Practice Address - Street 1:1320 YORK AVE STE 605
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10021-4800
Practice Address - Country:US
Practice Address - Phone:212-746-3278
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-09
Last Update Date:2021-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF342501363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily