Provider Demographics
NPI:1053856815
Name:RYBICKI, MICHELLE (LPN)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:
Last Name:RYBICKI
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18 PAVILION RIDGE WAY
Mailing Address - Street 2:APT 8
Mailing Address - City:SUFFERN
Mailing Address - State:NY
Mailing Address - Zip Code:10901-4663
Mailing Address - Country:US
Mailing Address - Phone:845-742-3059
Mailing Address - Fax:
Practice Address - Street 1:18 PAVILION RIDGE WAY
Practice Address - Street 2:APT 8
Practice Address - City:SUFFERN
Practice Address - State:NY
Practice Address - Zip Code:10901-4663
Practice Address - Country:US
Practice Address - Phone:845-742-3059
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-01-03
Last Update Date:2017-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY314180164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse