Provider Demographics
NPI:1801029897
Name:GIBBS, MICHELLE ELIZABETH (CRNA)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:ELIZABETH
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 1:1532 TULANE AVE
Mailing Address - Street 2:
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70112-2860
Mailing Address - Country:US
Mailing Address - Phone:504-903-1890
Mailing Address - Fax:504-903-2001
Practice Address - Street 1:1532 TULANE AVE
Practice Address - Street 2:
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70112-2860
Practice Address - Country:US
Practice Address - Phone:504-903-1890
Practice Address - Fax:504-903-2001
Is Sole Proprietor?:No
Enumeration Date:2009-08-25
Last Update Date:2015-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LARN103822/AP05850367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1809241Medicaid
MS09871868Medicaid
LA1809241Medicaid