Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 176B00000X | Midwife | 0129000085 | VA |
NPI | 1033552526 |
---|---|
Provider Name | Kristen Gibson |
First Address | Troutville, VA 24175-6806 |
Second Address | Troutville, VA 24175-6806 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 15/04/2013 |
Last Update Date | 15/04/2013 |