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NPI Profile for RYAN GRANGE in EDGEWOOD, NM.
Specialty |
Taxonomy Code | Specialty Code | Provider Type | |
Medical |
363AM0700X | 97 | Physician Assistant |
| NPI Number | 1295194629 |
|
| Status | Active | |
| Credentials | PA (Physician Assistant) | |
| Entity | Individual | |
| Enumeration date | 02/12/2016 | |
| Last updated | 04/14/2016 - About 10 years ago | |
| Sole proprietor 1 | No | |
| Identifiers |
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| Hospital affiliation(s) |
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RYAN GRANGE
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RYAN GRANGE, PA