Individual
MRS. PEGGY A RYAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
APRN,BC,ANP
Contact information
Practice address
3512 STELLHORN RD, FORT WAYNE, IN 46815-4631
(260) 483-9081
Mailing address
7887 N OLD STATE ROAD 37, BLOOMINGTON, IN 47408-9443
(812) 339-5677
Taxonomy
Speciality
Code
Description
License number
State
363LA2200X
Adult Health Nurse Practitioner
Primary
71000242A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
28068822A
RN
IN
01
—
71000242A
NURSE PRACTITIONER
IN
01
—
71000242B
CSR
IN
Enumeration date
10/13/2005
Last updated
05/03/2013
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