Healthcare Provider Details

I. General information

NPI: 1831033117
Provider Name (Legal Business Name): BRONSON GIBBONS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/16/2026
Last Update Date: 04/16/2026
Certification Date: 04/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

31710 190TH RD
RIVERDALE NE
68870-7046
US

IV. Provider business mailing address

31710 190TH RD
RIVERDALE NE
68870-7046
US

V. Phone/Fax

Practice location:
  • Phone: 308-627-0274
  • Fax:
Mailing address:
  • Phone: 308-627-0274
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3747A0650X
TaxonomyAttendant Care Provider
License Number
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: