MEDICARE: ANNA RYBAK GNP

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	363LG0600X	Gerontology Nurse Practitioner	2012012414	WI
2	363L00000X	Nurse Practitioner	5144-33	WI

General Provider Information

NPI Number	:	1821349051
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANNA RYBAK GNP

Provider Business Mailing Address
First Line	:	1604 LAKEWOOD AVE
Second Line	:
City	:	MOUNT PLEASANT
State	:	WI
Zip	:	53403-3827
Country	:	US
Telephone Number	:	262-902-8299
Fax Number	:

Provider Business Practice Location Address
First Line	:	1604 LAKEWOOD AVE
Second Line	:
City	:	MOUNT PLEASANT
State	:	WI
Zip	:	53403-3827
Country	:	US
Telephone Number	:	262-902-8299
Fax Number	:

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

Provider Enumeration Date	:	09/27/2012
Last Update Date	:	01/17/2014

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