Provider Demographics
NPI:1356968820
Name:GIBBEMEYER, ELIZABETH LAURA (NP)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:LAURA
Last Name:GIBBEMEYER
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:4209 RIDGE TOP RD APT 410
Mailing Address - Street 2:
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22030-1120
Mailing Address - Country:US
Mailing Address - Phone:513-702-9430
Mailing Address - Fax:
Practice Address - Street 1:3700 JOSEPH SIEWICK DR STE 100
Practice Address - Street 2:
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22033-1737
Practice Address - Country:US
Practice Address - Phone:571-665-6467
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-01
Last Update Date:2024-03-28
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VA0024179602363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner