Provider Demographics
NPI:1003036559
Name:GIBSON, CHRISTINE (CNM)
Entity Type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:
Last Name:GIBSON
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:521 NORLEE ST
Mailing Address - Street 2:
Mailing Address - City:SEBASTOPOL
Mailing Address - State:CA
Mailing Address - Zip Code:95472-2765
Mailing Address - Country:US
Mailing Address - Phone:707-584-3528
Mailing Address - Fax:707-584-3924
Practice Address - Street 1:1370 MEDICAL CENTER DR
Practice Address - Street 2:SUITE E
Practice Address - City:ROHNERT PARK
Practice Address - State:CA
Practice Address - Zip Code:94928-2934
Practice Address - Country:US
Practice Address - Phone:707-584-3528
Practice Address - Fax:707-584-3924
Is Sole Proprietor?:No
Enumeration Date:2007-04-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CANMW1163363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health