MEDICARE: PIPER N GIBSON AHND, TND, DFM

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	101YP1600X	Pastoral Counselor	PWA-4543412	NM

General Provider Information

NPI Number	:	1700509536
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PIPER N GIBSON AHND, TND, DFM

Provider Business Mailing Address
First Line	:	1251 ONEIDA DR
Second Line	:
City	:	LAS CRUCES
State	:	NM
Zip	:	88005-0856
Country	:	US
Telephone Number	:	575-496-6113
Fax Number	:

Provider Business Practice Location Address
First Line	:	3850 FOOTHILLS RD STE 9
Second Line	:
City	:	LAS CRUCES
State	:	NM
Zip	:	88011-4632
Country	:	US
Telephone Number	:	575-323-3198
Fax Number	:

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

Provider Enumeration Date	:	09/26/2022
Last Update Date	:	09/26/2022

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