Provider Demographics
NPI:1306004833
Name:BIBB, MARY (IBCLC)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:
Last Name:BIBB
Suffix:
Gender:F
Credentials:IBCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:54 PINEHURST DR
Mailing Address - Street 2:
Mailing Address - City:JERICHO
Mailing Address - State:VT
Mailing Address - Zip Code:05465-2524
Mailing Address - Country:US
Mailing Address - Phone:802-899-4845
Mailing Address - Fax:
Practice Address - Street 1:54 PINEHURST DR
Practice Address - Street 2:
Practice Address - City:JERICHO
Practice Address - State:VT
Practice Address - Zip Code:05465-2524
Practice Address - Country:US
Practice Address - Phone:802-899-4845
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-31
Last Update Date:2008-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist