Provider Demographics
NPI:1891021028
Name:FUQUA, RYANELLE TRESE (RN)
Entity type:Individual
Prefix:MS
First Name:RYANELLE
Middle Name:TRESE
Last Name:FUQUA
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:19 FREEMAN ST
Mailing Address - Street 2:
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14215-2704
Mailing Address - Country:US
Mailing Address - Phone:716-308-2645
Mailing Address - Fax:716-608-1328
Practice Address - Street 1:19 FREEMAN ST
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14215-2704
Practice Address - Country:US
Practice Address - Phone:716-308-2645
Practice Address - Fax:716-608-1328
Is Sole Proprietor?:No
Enumeration Date:2009-10-22
Last Update Date:2024-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY291556164W00000X
NY881719163WE0900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WE0900XNursing Service ProvidersRegistered NurseEnterostomal Therapy
No164W00000XNursing Service ProvidersLicensed Practical Nurse