| NPI | 1124705660 |
|---|---|
| Former Name | SUSAN CAROL HIBBS-SUNDEM |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: OR 10015313) |
| Enumeration Date | 2023-06-28 |
| Last Update Date | 2024-03-11 |