Active NPI
Maryellen Hibbard, FNP
- Family Nurse Practitioner
- Gresham, OR
National Provider Identifier
1497954994
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Nurse Practitioner
- License
- 200150111NP
- Practice address
- 831 NW Council Dr
Suite 300
Gresham, OR 97030-3721 - Phone
- (503) 408-4078
- Fax
- (503) 408-4077
- NPI assigned
- Jul 13, 2007
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Nurse Practitioner | 363LF0000X | 200150111NP | OR | Primary |
Addresses
Primary practice location
831 NW Council Dr
Suite 300
Gresham, OR 97030-3721
Mailing address
831 NW Council Dr
Suite 300
Gresham, OR 97030-3721
Phone (503) 408-4078
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 200150111NP | OR | MD | Family Nurse Practitioner |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1184284800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1209945600000",
"number": "1497954994",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "831 NW COUNCIL DR",
"address_2": "SUITE 300",
"city": "GRESHAM",
"state": "OR",
"postal_code": "970303721",
"telephone_number": "503-408-4078",
"fax_number": "503-408-4077"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "831 NW COUNCIL DR",
"address_2": "SUITE 300",
"city": "GRESHAM",
"state": "OR",
"postal_code": "970303721",
"telephone_number": "503-408-4078",
"fax_number": "503-408-4077"
}
],
"practiceLocations": [],
"basic": {
"last_name": "HIBBARD",
"first_name": "MARYELLEN",
"credential": "FNP",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2007-07-13",
"last_updated": "2008-05-05",
"status": "A"
},
"taxonomies": [
{
"code": "363LF0000X",
"taxonomy_group": "",
"desc": "Nurse Practitioner, Family",
"state": "OR",
"license": "200150111NP",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Gresham, OR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 5, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.