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General NPI Number Information
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NPI Number | 1386009363
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Entity Type | Individual
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Provider Name | JONATHAN GIBSON CRNA
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Gender | Male
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Dates
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Enumeration Date | 12/17/2015
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Last Update Date | 12/17/2015
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Provider Practice Location Address
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Address Line | 3901 S 7TH ST
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City | TERRE HAUTE
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State | IN
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Zip | 47802-5709
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Country | US
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Telephone | 812-865-9738
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Fax |
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Provider Business Mailing Address
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Address Line | 305 E 23RD ST
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City | HOPKINSVILLE
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State | KY
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Zip | 42240-3705
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Country | US
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Telephone | 270-839-4105
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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 | 367500000X
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Taxonomy Name | Certified Registered Nurse Anesthetist
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License Number | 28219802A
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License Number State | IN
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