MEDICARE: ANN GIBSON

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	133NN1002X	Nutrition Education Nutritionist

General Provider Information

NPI Number	:	1932406808
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANN GIBSON

Provider Business Mailing Address
First Line	:	1035 PEARL ST
Second Line	:	#312
City	:	BOULDER
State	:	CO
Zip	:	80302-5130
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1035 PEARL ST
Second Line	:	#312
City	:	BOULDER
State	:	CO
Zip	:	80302-5130
Country	:	US
Telephone Number	:	303-993-4359
Fax Number	:

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

Provider Enumeration Date	:	02/11/2011
Last Update Date	:	02/11/2011

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Directions to “ ANN GIBSON ” Practice Location

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