Basic Information
Provider Information
NPI: 1336556810
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: RYAN
FirstName: ALLISON
MiddleName: E
NamePrefix:  
NameSuffix:  
Credential: APRN
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 253 PLEASANT ST
Address2:  
City: CONCORD
State: NH
PostalCode: 033017560
CountryCode: US
TelephoneNumber: 6032262200
FaxNumber:  
Practice Location
Address1: 253 PLEASANT ST
Address2:  
City: CONCORD
State: NH
PostalCode: 033017560
CountryCode: US
TelephoneNumber: 6032262200
FaxNumber:  
Other Information
ProviderEnumerationDate: 07/17/2014
LastUpdateDate: 07/07/2022
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 07/07/2022

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
363LF0000X059703-23NHY Physician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily

No ID Information.


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