Provider Demographics
NPI:1497930788
Name:BIBEAU, JENNIFER L (RN)
Entity Type:Individual
Prefix:MS
First Name:JENNIFER
Middle Name:L
Last Name:BIBEAU
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:275 CUMBERLAND BND
Mailing Address - Street 2:SUITE 269
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37228-1805
Mailing Address - Country:US
Mailing Address - Phone:615-726-3340
Mailing Address - Fax:615-734-1687
Practice Address - Street 1:275 CUMBERLAND BND
Practice Address - Street 2:SUITE 269
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37228-1805
Practice Address - Country:US
Practice Address - Phone:615-726-3340
Practice Address - Fax:615-734-1687
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-04
Last Update Date:2008-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNRN0000155987251J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251J00000XAgenciesNursing Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNRN0000155987OtherNURSING