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General NPI Number Information
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NPI Number | 1023263894
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Entity Type | Individual
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Provider Name | JUSTIN R GIBB CRNA
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Gender | Male
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Dates
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Enumeration Date | 11/20/2008
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Last Update Date | 05/21/2025
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Provider Practice Location Address
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Address Line | 1828 S MILLENIUM WAY
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City | MERIDIAN
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State | ID
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Zip | 83642-5036
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Country | US
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Telephone | 208-381-0262
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 2263
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City | IDAHO FALLS
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State | ID
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Zip | 83403-2263
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Country | US
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Telephone | 208-525-2090
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Fax | 208-523-8978
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 367500000X
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Taxonomy Name | Certified Registered Nurse Anesthetist
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License Number | RNA728
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License Number State | ID
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Taxonomy #2
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Taxonomy Code | 367500000X
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Taxonomy Name | Certified Registered Nurse Anesthetist
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License Number | 200860041CRNA
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License Number State | OR
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