Provider Demographics
NPI:1184940512
Name:HIBBEN, DENISE S (DEM)
Entity type:Individual
Prefix:MRS
First Name:DENISE
Middle Name:S
Last Name:HIBBEN
Suffix:
Gender:F
Credentials:DEM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2832 W SHERWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:ROSEBURG
Mailing Address - State:OR
Mailing Address - Zip Code:97471-2622
Mailing Address - Country:US
Mailing Address - Phone:541-580-9792
Mailing Address - Fax:
Practice Address - Street 1:2832 W SHERWOOD AVE
Practice Address - Street 2:
Practice Address - City:ROSEBURG
Practice Address - State:OR
Practice Address - Zip Code:97471-2622
Practice Address - Country:US
Practice Address - Phone:541-580-9792
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-09
Last Update Date:2017-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175M00000XOther Service ProvidersMidwife, Lay