Provider Demographics
NPI:1043601156
Name:GIBSON, JANET
Entity Type:Individual
Prefix:
First Name:JANET
Middle Name:
Last Name:GIBSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:JANET
Other - Middle Name:
Other - Last Name:MICHNIEWICZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:8025 BLACK HORSE PIKE
Mailing Address - Street 2:STE 501
Mailing Address - City:PLEASANTVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:08232-2967
Mailing Address - Country:US
Mailing Address - Phone:609-641-4675
Mailing Address - Fax:609-569-0439
Practice Address - Street 1:8025 BLACK HORSE PIKE
Practice Address - Street 2:STE 501
Practice Address - City:PLEASANTVILLE
Practice Address - State:NJ
Practice Address - Zip Code:08232-2967
Practice Address - Country:US
Practice Address - Phone:609-641-4675
Practice Address - Fax:609-569-0439
Is Sole Proprietor?:No
Enumeration Date:2015-02-10
Last Update Date:2021-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC24726363LF0000X
NJ26NJ00537600363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily