Provider Demographics
NPI:1073881033
Name:RYBA, NICHOLE M (PA)
Entity Type:Individual
Prefix:
First Name:NICHOLE
Middle Name:M
Last Name:RYBA
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2913 WINDMILL RD STE 7
Mailing Address - Street 2:
Mailing Address - City:SINKING SPRING
Mailing Address - State:PA
Mailing Address - Zip Code:19608-1680
Mailing Address - Country:US
Mailing Address - Phone:610-288-2908
Mailing Address - Fax:610-898-4832
Practice Address - Street 1:2913 WINDMILL RD STE 7
Practice Address - Street 2:
Practice Address - City:SINKING SPRING
Practice Address - State:PA
Practice Address - Zip Code:19608-1680
Practice Address - Country:US
Practice Address - Phone:610-288-2908
Practice Address - Fax:610-898-4832
Is Sole Proprietor?:No
Enumeration Date:2011-12-06
Last Update Date:2016-03-28
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PAMA055132363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA399466YG9CMedicare PIN
PA244614Medicare PIN