Provider Demographics
NPI:1245063619
Name:BIBBS, LORI JANAE
Entity type:Individual
Prefix:
First Name:LORI
Middle Name:JANAE
Last Name:BIBBS
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 1:709 BUTTERFIELD DR
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43615-6517
Mailing Address - Country:US
Mailing Address - Phone:419-340-5723
Mailing Address - Fax:
Practice Address - Street 1:135 LAKE SHORE AVE
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43609-2028
Practice Address - Country:US
Practice Address - Phone:419-340-5723
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-21
Last Update Date:2024-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care