Healthcare Provider Details

I. General information

NPI: 1073037255
Provider Name (Legal Business Name): BRIGETTE VYBORNY DNP, CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/31/2017
Last Update Date: 07/31/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1501 N CAMPBELL AVE
TUCSON AZ
85724-0001
US

IV. Provider business mailing address

4771 W JUNEBERRY LN
TUCSON AZ
85742-4144
US

V. Phone/Fax

Practice location:
  • Phone: 420-694-0111
  • Fax:
Mailing address:
  • Phone: 520-909-0614
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberCRNA1421
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: