Provider Information for 1780401653
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JAMIE RYAN
Sex: Female
NPI: 1780401653
Last Updated: 2024-09-23
Certification Date: 2024-09-23
Certification Date: 2024-09-23
Details
| Name | Value | ||||||||
|---|---|---|---|---|---|---|---|---|---|
| NPI | 1780401653 | ||||||||
| Enumeration Date | 2024-09-23 | ||||||||
| NPI Type | NPI-1 Individual | ||||||||
| Sole Proprietor | NO | ||||||||
| Status | Active | ||||||||
| Mailing Address | 120 RACINE PL MUNDELEIN, IL 60060-1819 United States Phone: 847-275-6882 | Fax: | ||||||||
| Primary Practice Address | 120 RACINE PL MUNDELEIN, IL 60060-1819 United States Phone: 847-275-6882 | Fax: | ||||||||
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