Provider Demographics
NPI:1093363798
Name:HIBDON, JENNA (RN, BSN, MPH)
Entity Type:Individual
Prefix:
First Name:JENNA
Middle Name:
Last Name:HIBDON
Suffix:
Gender:F
Credentials:RN, BSN, MPH
Other - Prefix:
Other - First Name:JENNA
Other - Middle Name:
Other - Last Name:GRANT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN, BSN, MPH
Mailing Address - Street 1:1025 W BARNETTE ST
Mailing Address - Street 2:
Mailing Address - City:FAIRBANKS
Mailing Address - State:AK
Mailing Address - Zip Code:99701-4539
Mailing Address - Country:US
Mailing Address - Phone:907-451-1663
Mailing Address - Fax:
Practice Address - Street 1:1025 W BARNETTE ST
Practice Address - Street 2:
Practice Address - City:FAIRBANKS
Practice Address - State:AK
Practice Address - Zip Code:99701-4539
Practice Address - Country:US
Practice Address - Phone:907-451-1663
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-27
Last Update Date:2019-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK138255163WC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC1500XNursing Service ProvidersRegistered NurseCommunity Health