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? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 363LP0808X | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Psychiatric/Mental Health | Group - Single Specialty |