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NPI Code Detail

MEDICARE: WILLIAM ROBERT GIBSON CRNA

MEDICARE: WILLIAM ROBERT GIBSON CRNA
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
1367500000XCertified Registered Nurse Anesthetist4704215191MI
2367500000XCertified Registered Nurse Anesthetist54459NC

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2WG215191OTHERMIBCBSM

General Provider Information

NPI Number : 1184603573
Entity Type Code : Individual
Provider Name (Legal Business Name) : WILLIAM ROBERT GIBSON CRNA
Provider Business Mailing Address
First Line : 3100 SPRING FOREST RD STE 130
Second Line :
City : RALEIGH
State : NC
Zip : 27616-2880
Country : US
Telephone Number : 919-882-0774
Fax Number : 919-873-9821
Provider Business Practice Location Address
First Line : 1705 TARBORO ST SW
Second Line :
City : WILSON
State : NC
Zip : 27893-3428
Country : US
Telephone Number : 252-399-8040
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/13/2006
Last Update Date : 07/21/2022

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