Alta L Ryan

Primary specialty

Obstetrics & Gynecology Nurse PractitionerTaxonomy code 363LX0001X

License

209.000800 Issued in IL

Practice address

209 9TH St
Suite 200
Rockford, IL 61104-2235

Phone

(779) 696-2750

NPI assigned

Jul 11, 2006

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other names 1

• Alta Runkle Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1152576000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1435708800000",
    "number": "1639104359",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1567",
            "city": "ROCKFORD",
            "state": "IL",
            "postal_code": "611100067"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "209 9TH ST",
            "address_2": "SUITE 200",
            "city": "ROCKFORD",
            "state": "IL",
            "postal_code": "611042235",
            "telephone_number": "779-696-2750"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RYAN",
        "first_name": "ALTA",
        "middle_name": "L",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-07-11",
        "last_updated": "2015-07-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LX0001X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Obstetrics & Gynecology",
            "state": "IL",
            "license": "209.000800",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "ALTA",
            "last_name": "RUNKLE",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Briana Russom, PA-C
• Ruth Taggart, LLC
• Michelle Marie Rutherford, MOTR/L
• Caryn Ann Ruzic, APRN
• Ryan Health, Inc
• James Joseph Ryan, MSW LCSW
• Paige Lynn Ryan, LCSW
• Aneta Marzena Rychtarczyk, SLP
• Robert Ryder, LCPC
• Dipti Sabharwal, D.O

• Obstetrics & Gynecology Nurse Practitioner in Rockford, IL
• Providers in Rockford, IL by specialty
• Obstetrics & Gynecology Nurse Practitioner in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 1, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.