Provider Demographics
NPI:1700956703
Name:GIBIAN, JEANNE M (RN, CPNP)
Entity Type:Individual
Prefix:MRS
First Name:JEANNE
Middle Name:M
Last Name:GIBIAN
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Gender:F
Credentials:RN, CPNP
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Mailing Address - Street 1:2120 CENTERPOINTE WEST DR
Mailing Address - Street 2:PONDEROSA PEDIATRICS, P.L.C.
Mailing Address - City:PRESCOTT
Mailing Address - State:AZ
Mailing Address - Zip Code:86301
Mailing Address - Country:US
Mailing Address - Phone:928-778-4581
Mailing Address - Fax:928-776-1872
Practice Address - Street 1:2120 CENTERPOINTE WEST DR
Practice Address - Street 2:PONDEROSA PEDIATRICS, P.L.C.
Practice Address - City:PRESCOTT
Practice Address - State:AZ
Practice Address - Zip Code:86301
Practice Address - Country:US
Practice Address - Phone:928-778-4581
Practice Address - Fax:928-776-1872
Is Sole Proprietor?:No
Enumeration Date:2006-11-08
Last Update Date:2011-05-12
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Provider Licenses
StateLicense IDTaxonomies
AZAP1307363LP0200X
AZRN14260163WP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
No163WP0200XNursing Service ProvidersRegistered NursePediatrics