Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LC1500X | Nurse Practitioner - Community Health | 200150136NP | OR |
NPI | 1346301918 |
---|---|
Provider Name | Mary Ann Gibson |
First Address | Oregon City, OR 97045-2799 |
Second Address | Oregon City, OR 97045-4076 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/12/2006 |
Last Update Date | 23/11/2016 |