Provider Demographics
NPI:1205617529
Name:VANBIBBER, VANDA (PMHNP-BC)
Entity type:Individual
Prefix:
First Name:VANDA
Middle Name:
Last Name:VANBIBBER
Suffix:
Gender:F
Credentials:PMHNP-BC
Other - Prefix:
Other - First Name:VANDA
Other - Middle Name:
Other - Last Name:PERLMUTTER BAKER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:9397 CROWN CREST BLVD STE 440
Mailing Address - Street 2:
Mailing Address - City:PARKER
Mailing Address - State:CO
Mailing Address - Zip Code:80138-8789
Mailing Address - Country:US
Mailing Address - Phone:970-310-3406
Mailing Address - Fax:
Practice Address - Street 1:9397 CROWN CREST BLVD STE 440
Practice Address - Street 2:
Practice Address - City:PARKER
Practice Address - State:CO
Practice Address - Zip Code:80138-8789
Practice Address - Country:US
Practice Address - Phone:970-310-3406
Practice Address - Fax:888-965-4615
Is Sole Proprietor?:No
Enumeration Date:2023-10-12
Last Update Date:2024-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CORXN.0108282-NP163WP0808X
COAPN.0999228-NP363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health