MEDICARE: HANNAH ROSE WILSON GIBBS APRN

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	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	404041	NY
2	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	APRN.CNP.0030321	OH
3	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	11938-33	WI
4	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	AP61288327	WA
5	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	3014805	KY

General Provider Information

NPI Number	:	1649889932
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HANNAH ROSE WILSON GIBBS APRN

Provider Business Mailing Address
First Line	:	200 OCEANGATE
Second Line	:
City	:	LONG BEACH
State	:	CA
Zip	:	90802-4302
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	200 OCEANGATE
Second Line	:
City	:	LONG BEACH
State	:	CA
Zip	:	90802-4302
Country	:	US
Telephone Number	:	598-413-8904
Fax Number	:

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

Provider Enumeration Date	:	07/23/2020
Last Update Date	:	12/08/2022

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