Healthcare Provider Details

I. General information

NPI: 1356628226
Provider Name (Legal Business Name): KATHERINE B GIBBONS PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/07/2011
Last Update Date: 11/07/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6093 S QUEBEC ST STE 203
CENTENNIAL CO
80111-4544
US

IV. Provider business mailing address

6093 S QUEBEC ST STE 203
CENTENNIAL CO
80111-4544
US

V. Phone/Fax

Practice location:
  • Phone: 303-220-7906
  • Fax: 303-220-7907
Mailing address:
  • Phone: 303-220-7906
  • Fax: 303-220-7907

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133N00000X
TaxonomyNutritionist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: