Provider Demographics
NPI:1205101623
Name:GIBSON, ANNIE REBECCA (CRNP)
Entity type:Individual
Prefix:
First Name:ANNIE
Middle Name:REBECCA
Last Name:GIBSON
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9205 GOLD DUST CT
Mailing Address - Street 2:APARTMENT P
Mailing Address - City:LAUREL
Mailing Address - State:MD
Mailing Address - Zip Code:20723-1642
Mailing Address - Country:US
Mailing Address - Phone:267-979-0995
Mailing Address - Fax:
Practice Address - Street 1:9205 GOLD DUST CT
Practice Address - Street 2:APARTMENT P
Practice Address - City:LAUREL
Practice Address - State:MD
Practice Address - Zip Code:20723-1642
Practice Address - Country:US
Practice Address - Phone:267-979-0995
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-03-19
Last Update Date:2012-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR164959363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily