Provider Demographics
NPI:1922433929
Name:SIDIBEH, JAINABA
Entity Type:Individual
Prefix:
First Name:JAINABA
Middle Name:
Last Name:SIDIBEH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 3153
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98668-3153
Mailing Address - Country:US
Mailing Address - Phone:360-719-8844
Mailing Address - Fax:
Practice Address - Street 1:3013 NE WHITMAN AVE
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98662-3013
Practice Address - Country:US
Practice Address - Phone:360-719-8844
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-09-09
Last Update Date:2015-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR201391079RN163WP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health