Provider Demographics
NPI:1932406808
Name:GIBSON, ANN
Entity Type:Individual
Prefix:
First Name:ANN
Middle Name:
Last Name:GIBSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1035 PEARL ST
Mailing Address - Street 2:#312
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80302-5130
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1035 PEARL ST
Practice Address - Street 2:#312
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80302-5130
Practice Address - Country:US
Practice Address - Phone:303-993-4359
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-02-11
Last Update Date:2011-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133NN1002XDietary & Nutritional Service ProvidersNutritionistNutrition, Education