Provider Demographics
NPI:1508521915
Name:RIBACK, DANA MICHELLE (PA-C)
Entity Type:Individual
Prefix:
First Name:DANA
Middle Name:MICHELLE
Last Name:RIBACK
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8460 LIMEKILN PIKE APT 202
Mailing Address - Street 2:
Mailing Address - City:WYNCOTE
Mailing Address - State:PA
Mailing Address - Zip Code:19095-2603
Mailing Address - Country:US
Mailing Address - Phone:862-485-4094
Mailing Address - Fax:
Practice Address - Street 1:850 KNITTING MILLS WAY
Practice Address - Street 2:
Practice Address - City:WYOMISSING
Practice Address - State:PA
Practice Address - Zip Code:19610-3010
Practice Address - Country:US
Practice Address - Phone:610-376-8671
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-11-02
Last Update Date:2021-11-02
Deactivation Date:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant