Provider Demographics
NPI:1730871229
Name:RYAN, HEATHER MCSHANE HARKER (PHD, RN)
Entity type:Individual
Prefix:
First Name:HEATHER
Middle Name:MCSHANE HARKER
Last Name:RYAN
Suffix:
Gender:F
Credentials:PHD, RN
Other - Prefix:
Other - First Name:HEATHER
Other - Middle Name:MCSHANE
Other - Last Name:HARKER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:21 GILLOOLY RD # 2
Mailing Address - Street 2:
Mailing Address - City:CHELSEA
Mailing Address - State:MA
Mailing Address - Zip Code:02150-2233
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1493 CAMBRIDGE ST
Practice Address - Street 2:
Practice Address - City:CAMBRIDGE
Practice Address - State:MA
Practice Address - Zip Code:02139-1047
Practice Address - Country:US
Practice Address - Phone:617-665-1000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-23
Last Update Date:2023-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN2258972163W00000X
NY602313-1163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse