Provider Demographics
NPI:1659825024
Name:HIBBERT, SANDRA (RN)
Entity Type:Individual
Prefix:
First Name:SANDRA
Middle Name:
Last Name:HIBBERT
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 1:400 N BROADWAY ST
Mailing Address - Street 2:
Mailing Address - City:MOORE
Mailing Address - State:OK
Mailing Address - Zip Code:73160-4812
Mailing Address - Country:US
Mailing Address - Phone:405-735-4650
Mailing Address - Fax:
Practice Address - Street 1:400 N BROADWAY ST
Practice Address - Street 2:
Practice Address - City:MOORE
Practice Address - State:OK
Practice Address - Zip Code:73160-4812
Practice Address - Country:US
Practice Address - Phone:405-735-4650
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-15
Last Update Date:2016-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKR0066905163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse