Provider Demographics
NPI:1992590137
Name:HIBBERT, DAMARIS ASHLEY (LPN)
Entity type:Individual
Prefix:
First Name:DAMARIS
Middle Name:ASHLEY
Last Name:HIBBERT
Suffix:
Gender:
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:29 BARRINGTON DR
Mailing Address - Street 2:
Mailing Address - City:WHEATLEY HEIGHTS
Mailing Address - State:NY
Mailing Address - Zip Code:11798-1301
Mailing Address - Country:US
Mailing Address - Phone:646-221-4115
Mailing Address - Fax:
Practice Address - Street 1:19911 100TH AVE
Practice Address - Street 2:
Practice Address - City:JAMAICA
Practice Address - State:NY
Practice Address - Zip Code:11423-3317
Practice Address - Country:US
Practice Address - Phone:646-221-4115
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-04-09
Last Update Date:2025-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY353050164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse