Provider Demographics
NPI:1013122548
Name:GIBSON, MICHAEL FRANK (NP)
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:FRANK
Last Name:GIBSON
Suffix:
Gender:M
Credentials:NP
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Mailing Address - Street 1:1355 NORTH UNIVERSITY AVE
Mailing Address - Street 2:SUITE 210
Mailing Address - City:PROVO
Mailing Address - State:UT
Mailing Address - Zip Code:84604
Mailing Address - Country:US
Mailing Address - Phone:801-373-8930
Mailing Address - Fax:801-377-6811
Practice Address - Street 1:1355 NORTH UNIVERSITY AVE
Practice Address - Street 2:SUITE 210
Practice Address - City:PROVO
Practice Address - State:UT
Practice Address - Zip Code:84604
Practice Address - Country:US
Practice Address - Phone:801-373-8930
Practice Address - Fax:801-377-6811
Is Sole Proprietor?:No
Enumeration Date:2007-05-10
Last Update Date:2013-02-21
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
UT2668834405363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics