MEDICARE: RYAN WERBLOW M.S.N., RN, CRNA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163W00000X	Registered Nurse	201467	SC
2	163W00000X	Registered Nurse	RN622873	PA
3	163W00000X	Registered Nurse	RN60176013	WA

General Provider Information

NPI Number	:	1154765279
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RYAN WERBLOW M.S.N., RN, CRNA

Provider Business Mailing Address
First Line	:	5715 ELLSWORTH AVE
Second Line	:	APT B4
City	:	PITTSBURGH
State	:	PA
Zip	:	15232-1748
Country	:	US
Telephone Number	:	989-255-4846
Fax Number	:

Provider Business Practice Location Address
First Line	:	3000 NEW BERN AVE
Second Line	:
City	:	RALEIGH
State	:	NC
Zip	:	27610-1231
Country	:	US
Telephone Number	:	989-255-4846
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/19/2013
Last Update Date	:	04/19/2013

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