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General NPI Number Information
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NPI Number | 1144916297
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Entity Type | Individual
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Provider Name | MARY TERESA GIBSON ACNPC-AG
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Gender | Female
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Dates
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Enumeration Date | 04/12/2023
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Last Update Date | 04/12/2023
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Provider Practice Location Address
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Address Line | 13677 W MCDOWELL RD
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City | GOODYEAR
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State | AZ
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Zip | 85395-2635
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Country | US
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Telephone | 623-853-3832
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Fax |
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Provider Business Mailing Address
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Address Line | 14175 W INDIAN SCHOOL RD STE B4
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City | GOODYEAR
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State | AZ
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Zip | 85395-8494
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Country | US
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Telephone | 623-853-3832
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Fax |
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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 | 2086S0127X
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Taxonomy Name | Trauma Surgery Physician
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License Number | 290448
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License Number State | AZ
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