Mary Tibbe, MSN RN CCRN-K AGCNS

Primary specialty

Gerontology Clinical Nurse SpecialistTaxonomy code 364SG0600X

License

4704270663 Issued in MI

Practice address

100 Michigan St NE
Grand Rapids, MI 49503-2560

Phone

(616) 520-1135

NPI assigned

Jul 22, 2019

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Master of Science - Nursing, Registered Nurse

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1563753600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1563753600000",
    "number": "1699328393",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "18901 W KIMBALL RD",
            "city": "PIERSON",
            "state": "MI",
            "postal_code": "493399605"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "100 MICHIGAN ST NE",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495032560",
            "telephone_number": "616-520-1135"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TIBBE",
        "first_name": "MARY",
        "credential": "MSN RN CCRN-K AGCNS",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-07-22",
        "last_updated": "2019-07-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "364SG0600X",
            "taxonomy_group": "",
            "desc": "Clinical Nurse Specialist, Gerontology",
            "state": "MI",
            "license": "4704270663",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Brooke Marie Thurow
• Bobbi Anne Thursam, MD
• Galloway Thurston, MD
• Reece Lynn Thurston
• Laamy Nassara Tiadjeri, M.D.
• Melanie Tibbitts, LMSW
• Laurice Fran Tibble, MSW,CAC1
• Dustin Tibbs, PA-C
• Sherry Tichelaar
• Alexandra Tidd

• Gerontology Clinical Nurse Specialist in Grand Rapids, MI
• Providers in Grand Rapids, MI by specialty
• Gerontology Clinical Nurse Specialist in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 22, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.