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NPI Code Detail

MEDICARE: CARLA ANNETTE GIBSON-DETERING FNP

MEDICARE:   CARLA ANNETTE GIBSON-DETERING  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
1363L00000XNurse PractitionerNC

General Provider Information

NPI Number : 1164483343
Entity Type Code : Individual
Provider Name (Legal Business Name) : CARLA ANNETTE GIBSON-DETERING FNP
Provider Business Mailing Address
First Line : PO BOX 601409
Second Line :
City : CHARLOTTE
State : NC
Zip : 28260-1409
Country : US
Telephone Number : 919-477-5152
Fax Number : 919-477-5474
Provider Business Practice Location Address
First Line : 201 E GROVER ST
Second Line :
City : SHELBY
State : NC
Zip : 28150-3917
Country : US
Telephone Number : 704-487-3798
Fax Number : 704-487-3394
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/29/2006
Last Update Date : 04/04/2008

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Directions to “ CARLA ANNETTE GIBSON-DETERING FNP” Practice Location

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