MEDICARE: CHERYL L. GIBSON FNP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LP2300X	Primary Care Nurse Practitioner	18243	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	18243	OTHER	CA	BOARD OF NURSING

General Provider Information

NPI Number	:	1134371180
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHERYL L. GIBSON FNP

Provider Business Mailing Address
First Line	:	200 W CENTER STREET PROMENADE STE 400
Second Line	:
City	:	ANAHEIM
State	:	CA
Zip	:	92805-3960
Country	:	US
Telephone Number	:	714-449-4800
Fax Number	:	714-449-4956

Provider Business Practice Location Address
First Line	:	8911 LAKEWOOD DR STE 13
Second Line	:
City	:	WINDSOR
State	:	CA
Zip	:	95492-7857
Country	:	US
Telephone Number	:	707-387-3910
Fax Number	:	707-836-1942

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/21/2008
Last Update Date	:	03/17/2018

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