Healthcare Provider Details

I. General information

NPI: 1053678037
Provider Name (Legal Business Name): LINDA L. GIBSON RN, CNS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/16/2012
Last Update Date: 04/16/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10535 HOSPITAL WAY
MATHER CA
95655-4200
US

IV. Provider business mailing address

10535 HOSPITAL WAY
MATHER CA
95655-4200
US

V. Phone/Fax

Practice location:
  • Phone: 916-869-1555
  • Fax:
Mailing address:
  • Phone: 916-869-1555
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code364SP0809X
TaxonomyAdult Psychiatric/Mental Health Clinical Nurse Specialist
License Number0239976
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code163WP0809X
TaxonomyAdult Psychiatric/Mental Health Registered Nurse
License NumberRN237976L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: