1760270078 NPI number — CHRISTINE ALICE JIBILIAN MASTERS STUDENT

Table of content: CHRISTINE ALICE JIBILIAN MASTERS STUDENT (NPI 1760270078)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1760270078 NPI number — CHRISTINE ALICE JIBILIAN MASTERS STUDENT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
JIBILIAN
Provider First Name:
CHRISTINE
Provider Middle Name:
ALICE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MASTERS STUDENT
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1760270078
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/28/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 860
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CHATHAM
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
24531-0860
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
434-421-0891
Provider Business Mailing Address Fax Number:
855-233-1727

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
300 FRANKLIN ST STE 242
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MARTINSVILLE
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
24112-1802
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
434-421-0891
Provider Business Practice Location Address Fax Number:
855-233-1727
Provider Enumeration Date:
04/28/2025

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101Y00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





Copyright © 2007-2025 www.npivalidator.com