Individual
THOMAS P RYAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
NP
Contact information
Practice address
700 W IRONWOOD DR STE 378, COEUR D ALENE, ID 83814-4401
(208) 625-3555
(208) 625-1494
Mailing address
2003 KOOTENAI HEALTH WAY, COEUR D ALENE, ID 83814-6051
(208) 625-3555
(208) 765-1494
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
NP69133
ID
363LA2100X
Acute Care Nurse Practitioner
96119
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
7161988
DOB
TN
Enumeration date
10/20/2020
Last updated
04/26/2024
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