Provider Demographics
NPI:1679777676
Name:GIBSON, ROBERT C (ACNP)
Entity Type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:C
Last Name:GIBSON
Suffix:
Gender:M
Credentials:ACNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3107 MILFORD TER
Mailing Address - Street 2:
Mailing Address - City:HAMBURG
Mailing Address - State:NY
Mailing Address - Zip Code:14075-2436
Mailing Address - Country:US
Mailing Address - Phone:716-912-2282
Mailing Address - Fax:
Practice Address - Street 1:3107 MILFORD TER
Practice Address - Street 2:
Practice Address - City:HAMBURG
Practice Address - State:NY
Practice Address - Zip Code:14075-2436
Practice Address - Country:US
Practice Address - Phone:716-912-2282
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY43430325363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care