Healthcare Provider Details

I. General information

NPI: 1487715959
Provider Name (Legal Business Name): JILL NIXON HIBBERT CNM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/12/2006
Last Update Date: 04/17/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4379 RIDGEWOOD CENTER DR STE 102
WOODBRIDGE VA
22192-8323
US

IV. Provider business mailing address

2101 E JEFFERSON ST PPQA MEDICARE COMPLIANCE UNIT 6 WEST ATTN THERESA BROOK
ROCKVILLE MD
20852-4908
US

V. Phone/Fax

Practice location:
  • Phone: 703-680-7950
  • Fax: 703-680-7953
Mailing address:
  • Phone: 301-816-2414
  • Fax: 301-388-1740

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code176B00000X
TaxonomyMidwife
License Number0001161499
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code176B00000X
TaxonomyMidwife
License Number0024161499
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: