1871900423 NPI number — ANNA TRYBUS APRN

Table of content: ANNA TRYBUS APRN (NPI 1871900423)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1871900423 NPI number — ANNA TRYBUS APRN

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
TRYBUS
Provider First Name:
ANNA
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
APRN
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1871900423
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/13/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2380 W HORIZON RIDGE PKWY
Provider Second Line Business Mailing Address:
SUITE 110
Provider Business Mailing Address City Name:
HENDERSON
Provider Business Mailing Address State Name:
NV
Provider Business Mailing Address Postal Code:
89052-5078
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
702-823-4255
Provider Business Mailing Address Fax Number:
702-475-3261

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3001 SAINT ROSE PKWY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HENDERSON
Provider Business Practice Location Address State Name:
NV
Provider Business Practice Location Address Postal Code:
89052-3839
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
702-616-5000
Provider Business Practice Location Address Fax Number:
702-616-5511
Provider Enumeration Date:
07/15/2014

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363L00000X , with the licence number:  APRN001858 , registered in the state of NV ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 163W00000X , with the licence number: RN70959 , registered in the state of NV ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)