Individual
EMILIE KOEPKE GIBBS
Active
Individual
EMILIE KOEPKE GIBBS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
P.A.
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
001401
CT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
140100
CONNECTICARE
CT
01
—
290001401CT01
BLUE CROSS BLUE SHIELD
—
01
—
2V2497
HEALTHNET
CT
01
—
300461
PREFERRED ONE
CT
Enumeration date
10/04/2005
Last updated
04/06/2018
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