MEDICARE: MS. KATHLEEN E GIBBONS C.R.N.A.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	367500000X	Certified Registered Nurse Anesthetist	166540	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1174524235
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. KATHLEEN E GIBBONS C.R.N.A.

Provider Business Mailing Address
First Line	:	PO BOX 567
Second Line	:
City	:	CHAGRIN FALLS
State	:	OH
Zip	:	44022-0567
Country	:	US
Telephone Number	:	216-464-5160
Fax Number	:	216-464-5982

Provider Business Practice Location Address
First Line	:	15345 BAGLEY RD
Second Line	:
City	:	MIDDLEBURG HEIGHTS
State	:	OH
Zip	:	44130-4825
Country	:	US
Telephone Number	:	440-743-8400
Fax Number	:	440-743-8401

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/10/2005
Last Update Date	:	07/08/2007

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Directions to “ MS. KATHLEEN E GIBBONS C.R.N.A.” Practice Location

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