Provider Demographics
NPI:1851316202
Name:RYAN, MAURA S (NP)
Entity type:Individual
Prefix:
First Name:MAURA
Middle Name:S
Last Name:RYAN
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:107 LOCUST DR
Mailing Address - Street 2:
Mailing Address - City:WESTWOOD
Mailing Address - State:MA
Mailing Address - Zip Code:02090-3208
Mailing Address - Country:US
Mailing Address - Phone:781-784-9212
Mailing Address - Fax:
Practice Address - Street 1:93 POND ST
Practice Address - Street 2:
Practice Address - City:SHARON
Practice Address - State:MA
Practice Address - Zip Code:02067-2015
Practice Address - Country:US
Practice Address - Phone:781-784-9212
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-13
Last Update Date:2008-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA216239363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MANP1997Medicare ID - Type Unspecified
MAQ40231Medicare UPIN