Individual
JILL R GIBSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
35 MICHIGAN ST NE, SUITE 4150, GRAND RAPIDS, MI 49503-2514
(616) 267-2100
(616) 267-2101
Mailing address
15448 HOWARD ST, SPRING LAKE, MI 49456-1526
Taxonomy
Speciality
Code
Description
License number
State
363LP0200X
Pediatric Nurse Practitioner
Primary
4704165794
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
4631797
—
MI
01
—
500870355
BCBS PIN
MI
Enumeration date
06/07/2006
Last updated
01/28/2013
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