Provider Demographics
NPI:1811157274
Name:GIBSON, ELIZABETH (L AC)
Entity type:Individual
Prefix:MRS
First Name:ELIZABETH
Middle Name:
Last Name:GIBSON
Suffix:
Gender:F
Credentials:L AC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:260 GIBSON RD
Mailing Address - Street 2:
Mailing Address - City:PARKER
Mailing Address - State:PA
Mailing Address - Zip Code:16049-2018
Mailing Address - Country:US
Mailing Address - Phone:724-791-2148
Mailing Address - Fax:
Practice Address - Street 1:318 E JEFFERSON ST
Practice Address - Street 2:
Practice Address - City:BUTLER
Practice Address - State:PA
Practice Address - Zip Code:16001-6009
Practice Address - Country:US
Practice Address - Phone:724-285-7382
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-10
Last Update Date:2008-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAAK000921171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist