Provider Demographics
NPI:1306170683
Name:WYBORNY, LIBBY ANN (RN)
Entity type:Individual
Prefix:
First Name:LIBBY
Middle Name:ANN
Last Name:WYBORNY
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:805 7TH ST NE
Mailing Address - Street 2:
Mailing Address - City:KASSON
Mailing Address - State:MN
Mailing Address - Zip Code:55944-2016
Mailing Address - Country:US
Mailing Address - Phone:507-951-7268
Mailing Address - Fax:
Practice Address - Street 1:805 7TH ST NE
Practice Address - Street 2:
Practice Address - City:KASSON
Practice Address - State:MN
Practice Address - Zip Code:55944-2016
Practice Address - Country:US
Practice Address - Phone:507-951-7268
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-20
Last Update Date:2009-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNR1572896163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse