Healthcare Provider Details

I. General information

NPI: 1871607432
Provider Name (Legal Business Name): CHRISTIE JANE GIBBS CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/19/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1423 CHAPEL ST
NEW HAVEN CT
06511-4411
US

IV. Provider business mailing address

5132 AVALON HAVEN DR
NORTH HAVEN CT
06473-1641
US

V. Phone/Fax

Practice location:
  • Phone: 203-865-3852
  • Fax: 203-865-2983
Mailing address:
  • Phone: 203-915-1725
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberE57038
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: