Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363L00000X | Nurse Practitioner | 26NC08675800 | NJ |
NPI | 1003002858 |
---|---|
Provider Name | Amy R. Gibson |
First Address | Plainfield, NJ 07060-3253 |
Second Address | Plainfield, NJ 07060-3253 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 14/09/2007 |
Last Update Date | 14/09/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
Q35230 | (02) | NJ |