Healthcare Provider Details

I. General information

NPI: 1003732587
Provider Name (Legal Business Name): ELEANOR ANN GIBSON BSN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/29/2026
Last Update Date: 06/29/2026
Certification Date: 06/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2101 ELM ST N
FARGO ND
58102-2417
US

IV. Provider business mailing address

1117 13TH AVE N APT 202
FARGO ND
58102-2561
US

V. Phone/Fax

Practice location:
  • Phone: 701-232-3241
  • Fax:
Mailing address:
  • Phone: 612-263-3891
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number205191
License Number StateND

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: