Provider Demographics
NPI:1427092683
Name:HIBBS, DAVID GERALD (APRN)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:GERALD
Last Name:HIBBS
Suffix:
Gender:M
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3910 NE 99TH AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97220-3620
Mailing Address - Country:US
Mailing Address - Phone:503-917-5928
Mailing Address - Fax:503-917-5929
Practice Address - Street 1:1808 SE 182ND AVE
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97233-5120
Practice Address - Country:US
Practice Address - Phone:503-917-5928
Practice Address - Fax:503-917-5929
Is Sole Proprietor?:No
Enumeration Date:2006-06-16
Last Update Date:2020-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARN00156444163W00000X
WAAP30007167363LF0000X
OR200950024NP363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR500620347Medicaid
OR8857797OtherMEDICARE
OR9646985Medicaid