Individual
MARY ELLEN RYAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
20 WALL ST, BURLINGTON, MA 01803-4758
(617) 774-0774
Mailing address
13 TANSY AVE, STRATHAM, NH 03885-2289
(603) 682-6260
Taxonomy
Speciality
Code
Description
License number
State
363LP0200X
Pediatric Nurse Practitioner
Primary
042924-23-02
NH
363LP0200X
Pediatric Nurse Practitioner
RN178290
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
23YP02412NH01
ANTHEM
—
05
—
281670099
—
ME
05
—
30340376
—
NH
Enumeration date
10/31/2007
Last updated
01/24/2024
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