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NPI Code Detail

MEDICARE: NANCY MARIE GIBSON FNP

MEDICARE: NANCY MARIE GIBSON 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
1363LF0000XFamily Nurse Practitioner099007140N1OR

Other Identifiers

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

General Provider Information

NPI Number : 1669491866
Entity Type Code : Individual
Provider Name (Legal Business Name) : NANCY MARIE GIBSON FNP
Provider Business Mailing Address
First Line : 3727 NE MARTIN LUTHER KING JR BLVD
Second Line : ATTN: CREDENTIALING
City : PORTLAND
State : OR
Zip : 97212-1112
Country : US
Telephone Number : 503-775-4931
Fax Number : 503-788-7285
Provider Business Practice Location Address
First Line : 3727 NE MARTIN LUTHER KING JR BLVD
Second Line :
City : PORTLAND
State : OR
Zip : 97212-1112
Country : US
Telephone Number : 503-775-4931
Fax Number : 503-788-7285
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/19/2006
Last Update Date : 11/15/2011

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