Basic Information
| Provider Information | |||||||||
| NPI: | 1013655299 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | GLYBIN | ||||||||
| FirstName: | NATALIE | ||||||||
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| Mailing Information | |||||||||
| Address1: | 185 PINE ST APT 512 | ||||||||
| Address2: | |||||||||
| City: | MANCHESTER | ||||||||
| State: | CT | ||||||||
| PostalCode: | 060405880 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8608175119 | ||||||||
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| Practice Location | |||||||||
| Address1: | 326 WASHINGTON ST | ||||||||
| Address2: | |||||||||
| City: | NORWICH | ||||||||
| State: | CT | ||||||||
| PostalCode: | 063602740 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8608898331 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 05/26/2022 | ||||||||
| LastUpdateDate: | 09/01/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 09/01/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163W00000X | 119617 | CT | N | Nursing Service Providers | Registered Nurse | 367500000X | 10686 | CT | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Anesthetist, Certified Registered |
No ID Information.