Provider Demographics
NPI:1457827891
Name:GIBSON, GREGORY JAMES (CRNP)
Entity Type:Individual
Prefix:
First Name:GREGORY
Middle Name:JAMES
Last Name:GIBSON
Suffix:
Gender:M
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22 ST PAUL DR STE 200
Mailing Address - Street 2:
Mailing Address - City:CHAMBERSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17201-1036
Mailing Address - Country:US
Mailing Address - Phone:717-709-7922
Mailing Address - Fax:717-261-4915
Practice Address - Street 1:830 5TH AVE STE 201
Practice Address - Street 2:
Practice Address - City:CHAMBERSBURG
Practice Address - State:PA
Practice Address - Zip Code:17201-4224
Practice Address - Country:US
Practice Address - Phone:717-709-7970
Practice Address - Fax:717-709-7971
Is Sole Proprietor?:No
Enumeration Date:2018-10-23
Last Update Date:2018-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PATLRN054098163W00000X
PASP019752363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse