Provider Demographics
NPI:1275831752
Name:RUBY, LIBBY ZAN (CNM,NP)
Entity Type:Individual
Prefix:
First Name:LIBBY
Middle Name:ZAN
Last Name:RUBY
Suffix:
Gender:F
Credentials:CNM,NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1820 SALEM CHURCH RD
Mailing Address - Street 2:
Mailing Address - City:STEPHENS CITY
Mailing Address - State:VA
Mailing Address - Zip Code:22655-5641
Mailing Address - Country:US
Mailing Address - Phone:540-722-3470
Mailing Address - Fax:540-722-3475
Practice Address - Street 1:10 BAKER ST
Practice Address - Street 2:
Practice Address - City:WINCHESTER
Practice Address - State:VA
Practice Address - Zip Code:22601-4890
Practice Address - Country:US
Practice Address - Phone:540-722-3470
Practice Address - Fax:540-722-3475
Is Sole Proprietor?:No
Enumeration Date:2011-03-07
Last Update Date:2011-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024070577363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner