Provider Demographics
NPI:1982955696
Name:RYERSON, MICHELLE JOYCE (LPN)
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:JOYCE
Last Name:RYERSON
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:409 E WASHINGTON ST
Mailing Address - Street 2:APT 4
Mailing Address - City:SANDUSKY
Mailing Address - State:OH
Mailing Address - Zip Code:44870-2891
Mailing Address - Country:US
Mailing Address - Phone:419-366-8631
Mailing Address - Fax:
Practice Address - Street 1:409 E WASHINGTON ST
Practice Address - Street 2:APT 4
Practice Address - City:SANDUSKY
Practice Address - State:OH
Practice Address - Zip Code:44870-2891
Practice Address - Country:US
Practice Address - Phone:419-366-8631
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-21
Last Update Date:2012-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH126049164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse