Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LF0000X | Nurse Practitioner - Family Medicine | 0024173392 | VA |
NPI | 1003278847 |
---|---|
Provider Name | Nancy Gibson |
First Address | Newport News, VA 23606-4437 |
Second Address | Newport News, VA 23606-4437 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/03/2016 |
Last Update Date | 10/03/2020 |