Healthcare Provider Details

I. General information

NPI: 1578720827
Provider Name (Legal Business Name): MARTHA BLECHAR GIBBONS PHD, RN, CPNP, CS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/22/2008
Last Update Date: 05/22/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6669 BARNABY ST NW
WASHINGTON DC
20015-2331
US

IV. Provider business mailing address

6669 BARNABY ST NW
WASHINGTON DC
20015-2331
US

V. Phone/Fax

Practice location:
  • Phone: 202-364-3919
  • Fax: 202-364-3997
Mailing address:
  • Phone: 202-364-3919
  • Fax: 202-364-3997

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License NumberRN54062
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: