Provider Demographics
NPI:1649724915
Name:BIBB, BONNIE SUE (CRNP)
Entity type:Individual
Prefix:MRS
First Name:BONNIE
Middle Name:SUE
Last Name:BIBB
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:608 18TH ST N
Mailing Address - Street 2:
Mailing Address - City:BESSEMER
Mailing Address - State:AL
Mailing Address - Zip Code:35020-4859
Mailing Address - Country:US
Mailing Address - Phone:205-428-2810
Mailing Address - Fax:
Practice Address - Street 1:608 18TH ST N
Practice Address - Street 2:
Practice Address - City:BESSEMER
Practice Address - State:AL
Practice Address - Zip Code:35020-4859
Practice Address - Country:US
Practice Address - Phone:205-428-2810
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-08-04
Last Update Date:2016-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-130651363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health