Healthcare Provider Details

I. General information

NPI: 1780242412
Provider Name (Legal Business Name): MIKHAIL A RYBIN APRN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/29/2019
Last Update Date: 04/13/2026
Certification Date: 04/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3333 WILKINSON BLVD
CHARLOTTE NC
28208-5631
US

IV. Provider business mailing address

PO BOX 740013
ATLANTA GA
30374-0013
US

V. Phone/Fax

Practice location:
  • Phone: 704-393-7720
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number23487
License Number StateSC
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number5012957
License Number StateNC
# 3
Primary TaxonomyN
Taxonomy Code163WM0705X
TaxonomyMedical-Surgical Registered Nurse
License NumberRN264549
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: