Healthcare Provider Details

I. General information

NPI: 1770874661
Provider Name (Legal Business Name): ANNE MARIE GIBBONS CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/26/2011
Last Update Date: 12/17/2021
Certification Date: 12/15/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

ASSISI HOUSE, MERCY LIFE 600 RED HILL ROAD
ASTON PA
19014
US

IV. Provider business mailing address

1098 W BALTIMORE PIKE SUITE 3101
MEDIA PA
19063-5139
US

V. Phone/Fax

Practice location:
  • Phone: 610-659-5145
  • Fax:
Mailing address:
  • Phone: 610-891-9277
  • Fax: 610-891-7778

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code364SA2200X
TaxonomyAdult Health Clinical Nurse Specialist
License NumberSP011016
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: