Provider Demographics
NPI:1205208238
Name:GILBERTSON, MARY M (MSN,APRN, FNP-BC,)
Entity Type:Individual
Prefix:MS
First Name:MARY
Middle Name:M
Last Name:GILBERTSON
Suffix:
Gender:F
Credentials:MSN,APRN, FNP-BC,
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6515 MAIN ST STE 3
Mailing Address - Street 2:
Mailing Address - City:TRUMBULL
Mailing Address - State:CT
Mailing Address - Zip Code:06611-1388
Mailing Address - Country:US
Mailing Address - Phone:203-521-4733
Mailing Address - Fax:203-880-9484
Practice Address - Street 1:6515 MAIN ST STE 3
Practice Address - Street 2:
Practice Address - City:TRUMBULL
Practice Address - State:CT
Practice Address - Zip Code:06611-1388
Practice Address - Country:US
Practice Address - Phone:203-521-4733
Practice Address - Fax:203-521-4733
Is Sole Proprietor?:Yes
Enumeration Date:2015-10-29
Last Update Date:2023-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT9253202D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes202D00000XAllopathic & Osteopathic PhysiciansIntegrative MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT1205208238OtherAPRN