Provider Demographics
NPI:1760722300
Name:GIBSON, JANELL MARIE (LDEM)
Entity Type:Individual
Prefix:
First Name:JANELL
Middle Name:MARIE
Last Name:GIBSON
Suffix:
Gender:F
Credentials:LDEM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:506 5TH ST N
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:MT
Mailing Address - Zip Code:59019
Mailing Address - Country:US
Mailing Address - Phone:406-321-2158
Mailing Address - Fax:406-322-5080
Practice Address - Street 1:506 5TH ST N
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:MT
Practice Address - Zip Code:59019
Practice Address - Country:US
Practice Address - Phone:406-321-2158
Practice Address - Fax:406-322-5080
Is Sole Proprietor?:Yes
Enumeration Date:2013-02-19
Last Update Date:2013-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT808176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife