Individual
MR. RYAN VINCENZO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
2710 RIFE MEDICAL LN, ROGERS, AR 72758-1452
(913) 642-4900
(913) 381-0979
Mailing address
PO BOX 507, LOWELL, AR 72745-0507
(913) 642-4900
(913) 381-0979
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
C02693
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
175127001
—
AR
01
—
191841
MEDCOST
NC
05
—
8052600
—
NC
Enumeration date
07/28/2006
Last updated
11/05/2013
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