MEDICARE: MRS. COLLETTE GIBBONS MSN, PMHNP, FNP

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	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	SP029265	PA

General Provider Information

NPI Number	:	1275637837
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. COLLETTE GIBBONS MSN, PMHNP, FNP

Provider Business Mailing Address
First Line	:	135 TECHNOLOGY DR STE 204
Second Line	:
City	:	CANONSBURG
State	:	PA
Zip	:	15317-9549
Country	:	US
Telephone Number	:	724-399-3931
Fax Number	:	866-601-6186

Provider Business Practice Location Address
First Line	:	135 TECHNOLOGY DR STE 204
Second Line	:
City	:	CANONSBURG
State	:	PA
Zip	:	15317-9549
Country	:	US
Telephone Number	:	724-399-3931
Fax Number	:	866-601-3186

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

Provider Enumeration Date	:	09/12/2006
Last Update Date	:	05/14/2024

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