Individual
ELIZABETH RYAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
522 PRONGHORN PLACE, MORAN, WY 83013-8301
(307) 543-2514
Mailing address
PO BOX 428, JACKSON, WY 83001-0428
(307) 543-2514
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PT926
WY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
204777200
—
WY
Enumeration date
12/31/2018
Last updated
06/14/2021
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