Provider Demographics
NPI:1770874661
Name:GIBBONS, ANNE MARIE (CRNP)
Entity type:Individual
Prefix:
First Name:ANNE
Middle Name:MARIE
Last Name:GIBBONS
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1098 W BALTIMORE PIKE
Mailing Address - Street 2:SUITE 3101
Mailing Address - City:MEDIA
Mailing Address - State:PA
Mailing Address - Zip Code:19063-5139
Mailing Address - Country:US
Mailing Address - Phone:610-891-9277
Mailing Address - Fax:610-891-7778
Practice Address - Street 1:ASSISI HOUSE, MERCY LIFE
Practice Address - Street 2:600 RED HILL ROAD
Practice Address - City:ASTON
Practice Address - State:PA
Practice Address - Zip Code:19014
Practice Address - Country:US
Practice Address - Phone:610-659-5145
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-04-26
Last Update Date:2021-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP011016364SA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SA2200XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1770974661OtherNPI