Provider Demographics
NPI:1710918883
Name:HIBMA, RENEE K (NP)
Entity Type:Individual
Prefix:
First Name:RENEE
Middle Name:K
Last Name:HIBMA
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:50 INDUSTRIAL PARK DR
Mailing Address - Street 2:
Mailing Address - City:BANGOR
Mailing Address - State:MI
Mailing Address - Zip Code:49013
Mailing Address - Country:US
Mailing Address - Phone:269-427-7937
Mailing Address - Fax:269-427-5180
Practice Address - Street 1:5498 109TH AVE
Practice Address - Street 2:
Practice Address - City:PULLMAN
Practice Address - State:MI
Practice Address - Zip Code:49450
Practice Address - Country:US
Practice Address - Phone:269-236-5021
Practice Address - Fax:269-236-5411
Is Sole Proprietor?:No
Enumeration Date:2006-07-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704183457363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner