Provider Demographics
NPI:1306678388
Name:BIBBS, SUKHREET MICHELLE ERICKA (RN)
Entity type:Individual
Prefix:MRS
First Name:SUKHREET
Middle Name:MICHELLE ERICKA
Last Name:BIBBS
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:SUKHREET
Other - Middle Name:MICHELLE ERICKA
Other - Last Name:MCGANN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4502 S SALINA ST
Mailing Address - Street 2:
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13205-2731
Mailing Address - Country:US
Mailing Address - Phone:315-294-4558
Mailing Address - Fax:
Practice Address - Street 1:425 ROBINSON ST
Practice Address - Street 2:
Practice Address - City:BINGHAMTON
Practice Address - State:NY
Practice Address - Zip Code:13904-1775
Practice Address - Country:US
Practice Address - Phone:607-724-1391
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-17
Last Update Date:2024-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY845367163WP0807X, 163WA0400X, 163WG0000X, 163WM0705X, 163WP0808X, 163WP0809X, 163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No163WP0807XNursing Service ProvidersRegistered NursePsychiatric/Mental Health, Child & Adolescent
No163WA0400XNursing Service ProvidersRegistered NurseAddiction (Substance Use Disorder)
No163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice
No163WM0705XNursing Service ProvidersRegistered NurseMedical-Surgical
No163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health
No163WP0809XNursing Service ProvidersRegistered NursePsychiatric/Mental Health, Adult