Basic Information
| Provider Information | |||||||||
| NPI: | 1003002858 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | GIBSON | ||||||||
| FirstName: | AMY | ||||||||
| MiddleName: | R. | ||||||||
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| Credential: | APN-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1314 PARK AVE | ||||||||
| Address2: | |||||||||
| City: | PLAINFIELD | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 070603253 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9082228970 | ||||||||
| FaxNumber: | 9082228762 | ||||||||
| Practice Location | |||||||||
| Address1: | 1314 PARK AVE | ||||||||
| Address2: | |||||||||
| City: | PLAINFIELD | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 070603253 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9082228970 | ||||||||
| FaxNumber: | 9082228762 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/14/2007 | ||||||||
| LastUpdateDate: | 09/14/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363L00000X | 26NC08675800 | NJ | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner |
No ID Information.