Provider Demographics
NPI:1770834020
Name:GIBSON, ANNA BETH (REGISTERED NURSE)
Entity Type:Individual
Prefix:
First Name:ANNA
Middle Name:BETH
Last Name:GIBSON
Suffix:
Gender:F
Credentials:REGISTERED NURSE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:316 SYCHAR RD
Mailing Address - Street 2:
Mailing Address - City:MOUNT VERNON
Mailing Address - State:OH
Mailing Address - Zip Code:43050-1339
Mailing Address - Country:US
Mailing Address - Phone:740-358-3795
Mailing Address - Fax:
Practice Address - Street 1:316 SYCHAR RD
Practice Address - Street 2:
Practice Address - City:MOUNT VERNON
Practice Address - State:OH
Practice Address - Zip Code:43050-1339
Practice Address - Country:US
Practice Address - Phone:740-358-3795
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-26
Last Update Date:2017-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN.387008-163W00000X
OHPN142243164W00000X
OH400851590109376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No164W00000XNursing Service ProvidersLicensed Practical Nurse
No376K00000XNursing Service Related ProvidersNurse's Aide