Laura M. Van Ryn, PA-C

Primary specialty

Medical Physician AssistantTaxonomy code 363AM0700X

License

2772-023 Issued in WI

Practice address

411 Westwood Dr
Wausau, WI 54401-4152

Phone

(715) 847-2558

Fax

(715) 847-2752

NPI assigned

Jul 1, 2011

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other names 1

• Laura M. Otto Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

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

{
    "created_epoch": "1309478400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1370908800000",
    "number": "1871880591",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "411 WESTWOOD DR",
            "city": "WAUSAU",
            "state": "WI",
            "postal_code": "544014152",
            "telephone_number": "715-847-2558",
            "fax_number": "715-847-2752"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "411 WESTWOOD DR",
            "city": "WAUSAU",
            "state": "WI",
            "postal_code": "544014152",
            "telephone_number": "715-847-2558",
            "fax_number": "715-847-2752"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "VAN RYN",
        "first_name": "LAURA",
        "middle_name": "M.",
        "name_prefix": "Mrs.",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2011-07-01",
        "last_updated": "2013-06-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "WI",
            "license": "2772-023",
            "primary": true
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "LAURA",
            "last_name": "OTTO",
            "middle_name": "M.",
            "credential": "PA-C",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Minfang Utterback, RN
• Ann Marie Valentine, O.T.R.
• Alysia Van Boxtel
• Shelly Ann Van de Weerd, RN
• Bethany Van Dong, MS CCC-SLP
• Karen Vandenberg, PT
• Kelsey Vandenberg, DNP, APNP, AGNP-C
• Busisiwe Rose Vandriel, O.D.
• Mai See Vang Yang, R.N.
• Abby Vang

• Medical Physician Assistant in Wausau, WI
• Providers in Wausau, WI by specialty
• Medical Physician Assistant in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 11, 2013; 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.