Provider Demographics
NPI:1184047102
Name:GIBSON, KATHERINE (RN)
Entity type:Individual
Prefix:
First Name:KATHERINE
Middle Name:
Last Name:GIBSON
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1809 N 203RD ST
Mailing Address - Street 2:
Mailing Address - City:SHORELINE
Mailing Address - State:WA
Mailing Address - Zip Code:98133-3306
Mailing Address - Country:US
Mailing Address - Phone:206-533-8761
Mailing Address - Fax:425-252-2807
Practice Address - Street 1:1809 N 203RD ST
Practice Address - Street 2:
Practice Address - City:SHORELINE
Practice Address - State:WA
Practice Address - Zip Code:98133-3306
Practice Address - Country:US
Practice Address - Phone:206-533-8761
Practice Address - Fax:425-252-2807
Is Sole Proprietor?:Yes
Enumeration Date:2014-01-27
Last Update Date:2014-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARN00058546163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse