Joya Ryan, APN/CNP

Individual provider Active NPI Nurse Practitioner · Sullivan, IL

NPI 1801898085 · NPPES record last updated Jun 25, 2013

Key facts

NPI
1801898085
Entity type
Individual (NPI type 1)
Primary specialty
Nurse Practitioner 363L00000X
License
309000182 (IL)
Practice address
2 W Adams St
Sullivan, IL 61951-1943
Phone
(217) 728-7353
Fax
(217) 728-2580
NPI assigned
Jun 1, 2005
Sex
Female
Sole proprietor
No

Medicare participation

Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD)
Yes
Credentials
Certified Nurse Practitioner, Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
309000182ILMDNurse Practitioner

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Nurse Practitioner 363L00000X 309000182 IL Yes

Addresses

Primary practice location

2 W Adams St
Sullivan, IL 61951-1943

Mailing address

2 W Adams St
Sullivan, IL 61951-1943
Phone (217) 728-7353

Other identifiers

IdentifierTypeStateIssuer
0360710252MedicaidIL

Other providers in Sullivan, IL

All providers in Sullivan, IL · Nurse Practitioner in Illinois

Sources for this page

Verify at the official NPI Registry.