Healthcare Provider Details

I. General information

NPI: 1841392040
Provider Name (Legal Business Name): RONALD J BIBEY CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/01/2006
Last Update Date: 10/06/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

810 FAIRGROVE CHURCH RD
HICKORY NC
28602-9617
US

IV. Provider business mailing address

4038 PINECREST DR NE
HICKORY NC
28601-8750
US

V. Phone/Fax

Practice location:
  • Phone: 828-326-3809
  • Fax: 828-326-3371
Mailing address:
  • Phone: 828-326-3809
  • Fax: 828-326-3371

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number71743
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: