Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LW0102X | Nurse Practitioner - Women's Health | NMW1163 | CA |
NPI | 1003036559 |
---|---|
Provider Name | Christine Gibson |
First Address | Sebastopol, CA 95472-2765 |
Second Address | Rohnert Park, CA 94928-2934 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/04/2007 |
Last Update Date | 08/07/2007 |