Individual
WILLIAM G GIBSON IV
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
FNP-C
Contact information
Practice address
460 S ELIOT AVE, RUSH CITY, MN 55069-6505
(320) 358-0987
(320) 358-3422
Mailing address
PO BOX 370, RUSH CITY, MN 55069-0370
(320) 358-0987
(320) 358-3422
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
2512775
MN
363LF0000X
Family Nurse Practitioner
Primary
10136
MN
363LF0000X
Family Nurse Practitioner
COA.17029-NP
OH
Other
Enumeration date
09/23/2014
Last updated
08/22/2023
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