Provider Demographics
NPI:1992319248
Name:WAUGH, RYAN E (FNP)
Entity type:Individual
Prefix:
First Name:RYAN
Middle Name:E
Last Name:WAUGH
Suffix:
Gender:M
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:912 S WASHINGTON AVE STE B
Mailing Address - Street 2:
Mailing Address - City:SAGINAW
Mailing Address - State:MI
Mailing Address - Zip Code:48601-2578
Mailing Address - Country:US
Mailing Address - Phone:989-791-7900
Mailing Address - Fax:
Practice Address - Street 1:912 S WASHINGTON AVE STE B
Practice Address - Street 2:
Practice Address - City:SAGINAW
Practice Address - State:MI
Practice Address - Zip Code:48601-2578
Practice Address - Country:US
Practice Address - Phone:989-791-7900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-03
Last Update Date:2024-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704247667363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily