Provider Demographics
NPI:1902415193
Name:GILBERT, BRIAN G (NURSE PRACTITIONER)
Entity Type:Individual
Prefix:MR
First Name:BRIAN
Middle Name:G
Last Name:GILBERT
Suffix:
Gender:M
Credentials:NURSE PRACTITIONER
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Other - First Name:
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Mailing Address - Street 1:1217 KEARNEY ST STE 1
Mailing Address - Street 2:
Mailing Address - City:PORT HURON
Mailing Address - State:MI
Mailing Address - Zip Code:48060-3571
Mailing Address - Country:US
Mailing Address - Phone:810-982-2095
Mailing Address - Fax:810-982-8513
Practice Address - Street 1:1217 KEARNEY ST STE 1
Practice Address - Street 2:
Practice Address - City:PORT HURON
Practice Address - State:MI
Practice Address - Zip Code:48060-3571
Practice Address - Country:US
Practice Address - Phone:810-982-2095
Practice Address - Fax:810-982-8513
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-23
Last Update Date:2022-06-02
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI4704272809363L00000X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner