Provider Demographics
NPI:1407637374
Name:COLLETTE C. GIBBONS, NP, LLC
Entity Type:Organization
Organization Name:COLLETTE C. GIBBONS, NP, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:COLLETTE
Authorized Official - Middle Name:C
Authorized Official - Last Name:GIBBONS
Authorized Official - Suffix:
Authorized Official - Credentials:CRNP
Authorized Official - Phone:412-719-9176
Mailing Address - Street 1:343 OAK FOREST DR
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15216-1122
Mailing Address - Country:US
Mailing Address - Phone:412-719-9176
Mailing Address - Fax:
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:724-618-3853
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-10-09
Last Update Date:2023-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty