Provider Demographics
NPI:1578720827
Name:GIBBONS, MARTHA BLECHAR (PHD, RN, CPNP, CS)
Entity Type:Individual
Prefix:DR
First Name:MARTHA
Middle Name:BLECHAR
Last Name:GIBBONS
Suffix:
Gender:F
Credentials:PHD, RN, CPNP, CS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6669 BARNABY ST NW
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20015-2331
Mailing Address - Country:US
Mailing Address - Phone:202-364-3919
Mailing Address - Fax:202-364-3997
Practice Address - Street 1:6669 BARNABY ST NW
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20015-2331
Practice Address - Country:US
Practice Address - Phone:202-364-3919
Practice Address - Fax:202-364-3997
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-22
Last Update Date:2008-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCRN54062163WP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health