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General NPI Number Information
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NPI Number | 1760658249
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Entity Type | Individual
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Provider Name | KRISTEN ELIZABETH GIBB
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Gender | Female
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Dates
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Enumeration Date | 05/05/2008
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Last Update Date | 09/20/2012
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Provider Practice Location Address
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Address Line | 504 GATEHOUSE DR
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City | EAST WAREHAM
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State | MA
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Zip | 02538-1374
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Country | US
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Telephone | 339-235-9492
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Fax |
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Provider Business Mailing Address
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Address Line | 504 GATEHOUSE DR
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City | EAST WAREHAM
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State | MA
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Zip | 02538-1374
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Country | US
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Telephone | 339-235-9492
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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 | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | 279951
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License Number State | MA
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