Provider Demographics
NPI:1275637837
Name:GIBBONS, COLLETTE (MSN, PMHNP)
Entity Type:Individual
Prefix:MRS
First Name:COLLETTE
Middle Name:
Last Name:GIBBONS
Suffix:
Gender:F
Credentials:MSN, PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:135 TECHNOLOGY DR STE 204
Mailing Address - Street 2:
Mailing Address - City:CANONSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:15317-9549
Mailing Address - Country:US
Mailing Address - Phone:724-399-3931
Mailing Address - Fax:866-601-6186
Practice Address - Street 1:135 TECHNOLOGY DR STE 204
Practice Address - Street 2:
Practice Address - City:CANONSBURG
Practice Address - State:PA
Practice Address - Zip Code:15317-9549
Practice Address - Country:US
Practice Address - Phone:724-399-3931
Practice Address - Fax:866-601-3186
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-12
Last Update Date:2024-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAVP006633B363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner