Provider Demographics
NPI:1043767726
Name:HIBBITT, IVY LOU BAHIAN (APRN)
Entity Type:Individual
Prefix:MRS
First Name:IVY LOU
Middle Name:BAHIAN
Last Name:HIBBITT
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26 HOKU PUHIPAKA ST
Mailing Address - Street 2:
Mailing Address - City:KAHULUI
Mailing Address - State:HI
Mailing Address - Zip Code:96732-4527
Mailing Address - Country:US
Mailing Address - Phone:808-212-8787
Mailing Address - Fax:
Practice Address - Street 1:285 W KAAHUMANU AVE STE 205
Practice Address - Street 2:
Practice Address - City:KAHULUI
Practice Address - State:HI
Practice Address - Zip Code:96732-1623
Practice Address - Country:US
Practice Address - Phone:808-212-8787
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-09-09
Last Update Date:2020-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIAPRN 2160363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily