Provider Demographics
NPI:1982573812
Name:STEPHANIE GIBBONS NP PLLC
Entity type:Organization
Organization Name:STEPHANIE GIBBONS NP PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:STEPHANIE
Authorized Official - Middle Name:
Authorized Official - Last Name:GIBBONS
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:801-913-7271
Mailing Address - Street 1:1907 W 2ND ST
Mailing Address - Street 2:
Mailing Address - City:GRANDVIEW
Mailing Address - State:WA
Mailing Address - Zip Code:98930-1177
Mailing Address - Country:US
Mailing Address - Phone:801-913-7271
Mailing Address - Fax:
Practice Address - Street 1:1907 W 2ND ST
Practice Address - Street 2:
Practice Address - City:GRANDVIEW
Practice Address - State:WA
Practice Address - Zip Code:98930-1177
Practice Address - Country:US
Practice Address - Phone:801-913-7271
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-10-30
Last Update Date:2025-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric MedicineGroup - Multi-Specialty