Healthcare Provider Details

I. General information

NPI: 1538304621
Provider Name (Legal Business Name): SUSAN MARIE RONEY HIBBERD N.P.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/03/2008
Last Update Date: 08/12/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

147 N BRENT ST
VENTURA CA
93003-2809
US

IV. Provider business mailing address

PO BOX 6514
VENTURA CA
93006-6514
US

V. Phone/Fax

Practice location:
  • Phone: 805-766-3505
  • Fax:
Mailing address:
  • Phone: 805-766-3505
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WR0006X
TaxonomyRegistered Nurse First Assistant
License NumberRN544146
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License NumberNP95000716
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: