Provider Demographics
NPI:1932574092
Name:WIBBY, CHRISTINE
Entity type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:
Last Name:WIBBY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:125 W 200 S # 107
Mailing Address - Street 2:
Mailing Address - City:MOAB
Mailing Address - State:UT
Mailing Address - Zip Code:84532-2534
Mailing Address - Country:US
Mailing Address - Phone:435-487-9313
Mailing Address - Fax:435-309-1915
Practice Address - Street 1:125 W 200 S # 107
Practice Address - Street 2:
Practice Address - City:MOAB
Practice Address - State:UT
Practice Address - Zip Code:84532-2534
Practice Address - Country:US
Practice Address - Phone:435-487-9313
Practice Address - Fax:435-309-1915
Is Sole Proprietor?:No
Enumeration Date:2015-12-01
Last Update Date:2023-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COAPN.0992501-NP363LF0000X
CT006385363LF0000X
UT9433393-4405363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily