Individual
LISA COLETTE RYAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CRNP
Contact information
Practice address
4280 WATERMELON RD STE 112, NORTHPORT, AL 35473-5250
(205) 750-0030
(205) 750-0855
Mailing address
4280 WATERMELON RD STE 112, NORTHPORT, AL 35473-5250
(205) 750-0030
(205) 750-0855
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
1065521
AL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
051510187
BCBS
AL
05
—
226037
—
AL
Enumeration date
12/07/2005
Last updated
02/28/2022
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