Provider Demographics
NPI:1275042111
Name:BIBOUX, ABIGAIL
Entity Type:Individual
Prefix:
First Name:ABIGAIL
Middle Name:
Last Name:BIBOUX
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 1:88741 TORRENCE RD
Mailing Address - Street 2:
Mailing Address - City:NOTI
Mailing Address - State:OR
Mailing Address - Zip Code:97461-9703
Mailing Address - Country:US
Mailing Address - Phone:541-321-2195
Mailing Address - Fax:
Practice Address - Street 1:2222 COBURG RD STE 300
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97401-4988
Practice Address - Country:US
Practice Address - Phone:541-687-9447
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-09-22
Last Update Date:2017-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker