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Individual
NICOLE GIBSON
Active
Individual
NICOLE GIBSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DNP
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
CP000446
SD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
01-22224
MEDICA
—
01
—
435L7GI
MN BLUE SHIELD
MN
01
—
4994462
SD BCBS
SD
05
—
6828020
—
SD
01
—
9237752
DAKOTACARE
SD
01
—
931451047321
PREFERRED ONE
—
Enumeration date
06/03/2006
Last updated
02/13/2019
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