Provider Demographics
NPI:1326556309
Name:GIBSON, DUNIA THELMA (FNP)
Entity Type:Individual
Prefix:MS
First Name:DUNIA
Middle Name:THELMA
Last Name:GIBSON
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6010 BAY PKWY STE 901
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11204-6081
Mailing Address - Country:US
Mailing Address - Phone:718-238-2100
Mailing Address - Fax:
Practice Address - Street 1:30 PROSPECT ST
Practice Address - Street 2:
Practice Address - City:HACKENSACK
Practice Address - State:NJ
Practice Address - Zip Code:07601-6081
Practice Address - Country:US
Practice Address - Phone:551-996-5430
Practice Address - Fax:551-996-5729
Is Sole Proprietor?:Yes
Enumeration Date:2018-01-12
Last Update Date:2019-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ00903200363LF0000X
NY342462363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY342462OtherFAMILY NURSE PRACTITIONER
NY342462Medicaid
NY342462OtherFNP