Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP0808X | Nurse Practitioner - Psychiatric/Mental Health | 402712 | NY |
NPI | 1033763198 |
---|---|
Provider Name | Vivien Gibson |
First Address | Beacon, NY 12508-3926 |
Second Address | Fishkill, NY 12524-2810 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/07/2019 |
Last Update Date | 27/07/2019 |