Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 363LW0102X | Nurse Practitioner - Women's Health | UP000909G | PA |
N | 363LX0001X | Nurse Practitioner - Obstetrics & Gynecology | UP000909G | PA |
NPI | 1053302349 |
---|---|
Provider Name | Ms. Carol Cecilia Gibson |
First Address | Upper Marlboro, MD 20772-5207 |
Second Address | Arlington, VA 22211-1009 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/11/2005 |
Last Update Date | 08/07/2007 |