Healthcare Provider Details

I. General information

NPI: 1457742009
Provider Name (Legal Business Name): ALEXIS RYBNY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/17/2015
Last Update Date: 07/29/2020
Certification Date: 07/29/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

818 CONGRESS ST
PORTLAND ME
04102-3112
US

IV. Provider business mailing address

818 CONGRESS ST
PORTLAND ME
04102-3112
US

V. Phone/Fax

Practice location:
  • Phone: 207-773-8161
  • Fax:
Mailing address:
  • Phone: 301-300-0813
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License NumberR203065
License Number StateMD
# 2
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License NumberCNP171085
License Number StateME
# 3
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberR203065
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: