Provider Demographics
NPI:1720470800
Name:MORES, IAN BIBLANIAS (CRNA)
Entity Type:Individual
Prefix:
First Name:IAN
Middle Name:BIBLANIAS
Last Name:MORES
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4706 STELLABROOKE LN
Mailing Address - Street 2:
Mailing Address - City:ROSEDALE
Mailing Address - State:MD
Mailing Address - Zip Code:21237-3744
Mailing Address - Country:US
Mailing Address - Phone:443-625-9790
Mailing Address - Fax:
Practice Address - Street 1:4706 STELLABROOKE LN
Practice Address - Street 2:
Practice Address - City:ROSEDALE
Practice Address - State:MD
Practice Address - Zip Code:21237-3744
Practice Address - Country:US
Practice Address - Phone:443-625-9790
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-02-25
Last Update Date:2015-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR163797367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered