Provider Demographics
NPI:1366183063
Name:RATHEAL, RYAN SCOTT (APRN)
Entity type:Individual
Prefix:
First Name:RYAN
Middle Name:SCOTT
Last Name:RATHEAL
Suffix:
Gender:M
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:139 SAND LAKE ST
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89074-1654
Mailing Address - Country:US
Mailing Address - Phone:435-669-7517
Mailing Address - Fax:
Practice Address - Street 1:139 SAND LAKE ST
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89074-1654
Practice Address - Country:US
Practice Address - Phone:702-472-7445
Practice Address - Fax:800-306-1747
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-05
Last Update Date:2024-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV822415363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health