Provider Demographics
NPI:1770684136
Name:GIBBS, SANDRA F (CRNA)
Entity Type:Individual
Prefix:
First Name:SANDRA
Middle Name:F
Last Name:GIBBS
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:602 JACKSON ST
Mailing Address - Street 2:
Mailing Address - City:PETOSKEY
Mailing Address - State:MI
Mailing Address - Zip Code:49770-2220
Mailing Address - Country:US
Mailing Address - Phone:231-348-2795
Mailing Address - Fax:231-348-2031
Practice Address - Street 1:602 JACKSON ST
Practice Address - Street 2:
Practice Address - City:PETOSKEY
Practice Address - State:MI
Practice Address - Zip Code:49770-2220
Practice Address - Country:US
Practice Address - Phone:231-348-2795
Practice Address - Fax:231-348-2031
Is Sole Proprietor?:No
Enumeration Date:2006-09-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704106278367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered