MEDICARE: LORI A GIBSON ARNP

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	363LA2200X	Adult Health Nurse Practitioner	71003364A	IN

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	:	1235444209
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LORI A GIBSON ARNP

Provider Business Mailing Address
First Line	:	PO BOX 775985
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60677-5985
Country	:	US
Telephone Number	:	317-770-6900
Fax Number	:	317-770-6911

Provider Business Practice Location Address
First Line	:	205 NOBLE CREEK DR
Second Line	:
City	:	NOBLESVILLE
State	:	IN
Zip	:	46060-3117
Country	:	US
Telephone Number	:	317-773-8483
Fax Number	:	317-776-0442

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

Provider Enumeration Date	:	08/13/2010
Last Update Date	:	09/24/2020

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