Provider Demographics
NPI:1376311423
Name:GIBSON, CARRIE ANN (RN)
Entity Type:Individual
Prefix:
First Name:CARRIE
Middle Name:ANN
Last Name:GIBSON
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:CARRIE
Other - Middle Name:ANN
Other - Last Name:ROBINSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:14068 CRATER LAKE RD
Mailing Address - Street 2:
Mailing Address - City:ANACORTES
Mailing Address - State:WA
Mailing Address - Zip Code:98221-8592
Mailing Address - Country:US
Mailing Address - Phone:360-391-0335
Mailing Address - Fax:
Practice Address - Street 1:1315 E DIVISION ST
Practice Address - Street 2:
Practice Address - City:MOUNT VERNON
Practice Address - State:WA
Practice Address - Zip Code:98274-4134
Practice Address - Country:US
Practice Address - Phone:360-734-5410
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-12-18
Last Update Date:2023-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARN00169642163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health