Individual
DAVID GERALD HIBBS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
APRN
Contact information
Practice address
1808 SE 182ND AVE, PORTLAND, OR 97233-5120
(503) 917-5928
(503) 917-5929
Mailing address
3910 NE 99TH AVE, PORTLAND, OR 97220-3620
(503) 917-5928
(503) 917-5929
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
RN00156444
WA
363LF0000X
Family Nurse Practitioner
Primary
200950024NP
OR
363LF0000X
Family Nurse Practitioner
AP30007167
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
500620347
—
OR
01
—
8857797
MEDICARE
OR
05
—
9646985
—
OR
Enumeration date
06/16/2006
Last updated
11/09/2020
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