Provider Demographics
NPI:1326431941
Name:GIBSON, MEGAN (LM)
Entity Type:Individual
Prefix:
First Name:MEGAN
Middle Name:
Last Name:GIBSON
Suffix:
Gender:F
Credentials:LM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4521 S KENNETH PL
Mailing Address - Street 2:
Mailing Address - City:TEMPE
Mailing Address - State:AZ
Mailing Address - Zip Code:85282-7124
Mailing Address - Country:US
Mailing Address - Phone:480-686-1452
Mailing Address - Fax:480-383-6681
Practice Address - Street 1:4521 S KENNETH PL
Practice Address - Street 2:
Practice Address - City:TEMPE
Practice Address - State:AZ
Practice Address - Zip Code:85282-7124
Practice Address - Country:US
Practice Address - Phone:480-686-1452
Practice Address - Fax:480-383-6681
Is Sole Proprietor?:Yes
Enumeration Date:2015-03-06
Last Update Date:2015-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ0181176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife