Individual
ANDREA ELISE RYAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
3999 DUTCHMANS LANE, SUITE 6F, LOUISVILLE, KY 40207-4929
(502) 394-5678
(502) 394-5600
Mailing address
PO BOX 776351, CHICAGO, IL 60677-6351
(502) 588-9490
(502) 629-6217
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
TC417
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
PA2023
STATE LICENSE
KY
01
—
TC417
TEMP LICENSE
KY
Enumeration date
08/18/2010
Last updated
03/05/2021
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