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General NPI Number Information
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NPI Number | 1164651725
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Entity Type | Individual
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Provider Name | JENNIFER KATHRYN GIBSON-SNYDER MD
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Gender | Female
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Dates
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Enumeration Date | 07/04/2009
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Last Update Date | 05/20/2021
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Provider Practice Location Address
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Address Line | 500 W. BROADWAY PROVIDENCE SAINT PATRICK HOSPITAL
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City | MISSOULA
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State | MT
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Zip | 59802-4008
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Country | US
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Telephone | 206-680-1361
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Fax |
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Provider Business Mailing Address
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Address Line | P. O. BOX 34439 PROVIDENCE HEALTH AND SERVICES, MT
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City | SEATTLE
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State | WA
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Zip | 98214-1439
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Country | US
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Telephone |
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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 | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | ML60093524
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License Number State | WA
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