Provider Demographics
NPI:1568695070
Name:RYBSKI, JEANETTE STASIAK (APRN)
Entity Type:Individual
Prefix:
First Name:JEANETTE
Middle Name:STASIAK
Last Name:RYBSKI
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:JEANETTE
Other - Middle Name:DIANE
Other - Last Name:STASIAK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APRN
Mailing Address - Street 1:25 VERNONDALE DR
Mailing Address - Street 2:
Mailing Address - City:SOUTHINGTON
Mailing Address - State:CT
Mailing Address - Zip Code:06489-2137
Mailing Address - Country:US
Mailing Address - Phone:860-276-2473
Mailing Address - Fax:
Practice Address - Street 1:282 WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06106-3322
Practice Address - Country:US
Practice Address - Phone:860-545-9520
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-08-31
Last Update Date:2011-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT004177363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics