Provider Demographics
NPI:1265729438
Name:GIBSON, GAYE (RN, MS, PSYD)
Entity type:Individual
Prefix:MS
First Name:GAYE
Middle Name:
Last Name:GIBSON
Suffix:
Gender:F
Credentials:RN, MS, PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4925 SUMMIT VIEW CT
Mailing Address - Street 2:
Mailing Address - City:EL DORADO
Mailing Address - State:CA
Mailing Address - Zip Code:95623-4609
Mailing Address - Country:US
Mailing Address - Phone:530-409-7511
Mailing Address - Fax:
Practice Address - Street 1:419 MAIN ST
Practice Address - Street 2:SUITE 318
Practice Address - City:PLACERVILLE
Practice Address - State:CA
Practice Address - Zip Code:95667-5600
Practice Address - Country:US
Practice Address - Phone:530-409-7511
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-07
Last Update Date:2021-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA225338163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse