MEDICARE: MS. MARY M GILBERTSON MSN,APRN, FNP-BC,

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	202D00000X	Integrative Medicine Physician	9253	CT

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1205208238	OTHER	CT	APRN

General Provider Information

NPI Number	:	1205208238
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. MARY M GILBERTSON MSN,APRN, FNP-BC,

Provider Business Mailing Address
First Line	:	6515 MAIN ST STE 3
Second Line	:
City	:	TRUMBULL
State	:	CT
Zip	:	06611-1388
Country	:	US
Telephone Number	:	203-521-4733
Fax Number	:	203-880-9484

Provider Business Practice Location Address
First Line	:	6515 MAIN ST STE 3
Second Line	:
City	:	TRUMBULL
State	:	CT
Zip	:	06611-1388
Country	:	US
Telephone Number	:	203-521-4733
Fax Number	:	203-521-4733

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

Provider Enumeration Date	:	10/29/2015
Last Update Date	:	08/23/2023

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