Provider Demographics
NPI:1558123349
Name:GIBSON, ANGELA (CPT)
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:
Last Name:GIBSON
Suffix:
Gender:F
Credentials:CPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:838 N DELAWARE ST STE 9-1212
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46204-1127
Mailing Address - Country:US
Mailing Address - Phone:317-505-0076
Mailing Address - Fax:
Practice Address - Street 1:838 N DELAWARE ST STE 9-1212
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46204-1127
Practice Address - Country:US
Practice Address - Phone:317-505-0076
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-26
Last Update Date:2024-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN246RP1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246RP1900XTechnologists, Technicians & Other Technical Service ProvidersTechnician, PathologyPhlebotomy