MEDICARE: MARK GIBBS RN

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	163WS0200X	School Registered Nurse	RN 60303516	WA

General Provider Information

NPI Number	:	1326598574
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARK GIBBS RN

Provider Business Mailing Address
First Line	:	7711 1ST AVE NW
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98117-3008
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	9501 20TH AVE NE
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98115-2330
Country	:	US
Telephone Number	:	206-252-5557
Fax Number	:

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

Provider Enumeration Date	:	10/12/2016
Last Update Date	:	10/12/2016

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