Individual
GANNON RYAN NYQUIST
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
1310 CLUB DR, VALLEJO, CA 94592-1187
(707) 638-5809
Mailing address
624 N CASCADE AVE APT 41, COLORADO SPRINGS, CO 80903-3225
(505) 280-0158
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA213297
OR
363A00000X
Physician Assistant
—
—
Other
Enumeration date
05/14/2021
Last updated
09/12/2022
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