Individual
MARY REBECCA RYLANCE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
992 S BROADWAY ST, T OR C, NM 87901-3198
(505) 894-4275
Mailing address
992 S BROADWAY ST, T OR C, NM 87901-3198
(505) 894-4275
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
92-PA06
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
92PA06
PA CERTIFICATE
NM
Enumeration date
02/15/2007
Last updated
07/08/2007
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