Provider Demographics
NPI:1679065643
Name:RYAN, ELYSE NICOLE (MS)
Entity type:Individual
Prefix:
First Name:ELYSE
Middle Name:NICOLE
Last Name:RYAN
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:GENETIC DIAGNOSTIC LABORATORY
Mailing Address - Street 2:3620 HAMILTON WALK, ANATOMY & CHEMISTRY BUILDING, RM415
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19104
Mailing Address - Country:US
Mailing Address - Phone:215-573-9161
Mailing Address - Fax:
Practice Address - Street 1:GENETIC DIAGNOSTIC LABORATORY
Practice Address - Street 2:3620 HAMILTON WALK, ANATOMY & CHEMISTRY BLDG, RM 415
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19104
Practice Address - Country:US
Practice Address - Phone:215-573-9161
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-06-05
Last Update Date:2018-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes170300000XOther Service ProvidersGenetic Counselor, MS