Provider Demographics
NPI:1881630085
Name:HIBDON, MARIA RECURT (FNP)
Entity Type:Individual
Prefix:MS
First Name:MARIA
Middle Name:RECURT
Last Name:HIBDON
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:406 SUNRISE AVE
Mailing Address - Street 2:SUITE 280
Mailing Address - City:ROSEVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95661-4106
Mailing Address - Country:US
Mailing Address - Phone:916-782-3786
Mailing Address - Fax:916-773-6251
Practice Address - Street 1:406 SUNRISE AVE
Practice Address - Street 2:SUITE 280
Practice Address - City:ROSEVILLE
Practice Address - State:CA
Practice Address - Zip Code:95661-4106
Practice Address - Country:US
Practice Address - Phone:916-782-3786
Practice Address - Fax:916-773-6251
Is Sole Proprietor?:No
Enumeration Date:2006-06-22
Last Update Date:2012-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA285715363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G527460Medicaid
CA00G527460Medicaid
A52337Medicare UPIN