Provider Demographics
NPI:1275240285
Name:CUMMINGS, BIBIAN CHIAGOZIE
Entity Type:Individual
Prefix:
First Name:BIBIAN
Middle Name:CHIAGOZIE
Last Name:CUMMINGS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1830 40TH AVE S APT 116
Mailing Address - Street 2:
Mailing Address - City:MOORHEAD
Mailing Address - State:MN
Mailing Address - Zip Code:56560-7923
Mailing Address - Country:US
Mailing Address - Phone:320-304-4324
Mailing Address - Fax:
Practice Address - Street 1:1830 40TH AVE S APT 116
Practice Address - Street 2:
Practice Address - City:MOORHEAD
Practice Address - State:MN
Practice Address - Zip Code:56560-7923
Practice Address - Country:US
Practice Address - Phone:701-936-1545
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-10-31
Last Update Date:2022-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND3747P1801X3747P1801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant