Provider Demographics
NPI:1760865398
Name:GIBSON, JOANNE (RDN, LDN, CLT)
Entity Type:Individual
Prefix:
First Name:JOANNE
Middle Name:
Last Name:GIBSON
Suffix:
Gender:F
Credentials:RDN, LDN, CLT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:394 TURNER RD
Mailing Address - Street 2:
Mailing Address - City:WALLINGFORD
Mailing Address - State:PA
Mailing Address - Zip Code:19086-6039
Mailing Address - Country:US
Mailing Address - Phone:610-322-5588
Mailing Address - Fax:
Practice Address - Street 1:394 TURNER RD
Practice Address - Street 2:
Practice Address - City:WALLINGFORD
Practice Address - State:PA
Practice Address - Zip Code:19086-6039
Practice Address - Country:US
Practice Address - Phone:610-322-5588
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-01
Last Update Date:2015-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADN002491133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered