Healthcare Provider Details

I. General information

NPI: 1518916071
Provider Name (Legal Business Name): JOAN MARIE GIBSON CNS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/10/2006
Last Update Date: 06/19/2025
Certification Date: 06/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11800 SINGLETREE LN STE 204
EDEN PRAIRIE MN
55344-5397
US

IV. Provider business mailing address

11800 SINGLETREE LN STE 312
EDEN PRAIRIE MN
55344-5398
US

V. Phone/Fax

Practice location:
  • Phone: 612-440-6557
  • Fax:
Mailing address:
  • Phone: 612-440-6557
  • Fax: 612-500-4964

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code364SP0809X
TaxonomyAdult Psychiatric/Mental Health Clinical Nurse Specialist
License NumberR131810-2
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: