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Individual

ILENE HIBBERT

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F

Contact information

Practice address
7668 SW MOHAWK ST, TUALATIN, OR 97062-8119
(503) 885-5110
(866) 350-1311
Mailing address
7668 SW MOHAWK ST, TUALATIN, OR 97062-8119
(503) 885-5110
(866) 350-1311

Taxonomy

Speciality
Code
Description
License number
State
302R00000X
Health Maintenance Organization
Primary
093003236RN
OR

Other

Enumeration date
04/09/2014
Last updated
04/09/2014
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