Individual
WILLIAM ROBERT GIBSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
1705 TARBORO ST SW, WILSON, NC 27893-3428
(252) 399-8040
Mailing address
3100 SPRING FOREST RD STE 130, RALEIGH, NC 27616-2880
(919) 882-0774
(919) 873-9821
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
4704215191
MI
367500000X
Certified Registered Nurse Anesthetist
Primary
54459
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
4510719
—
MI
01
—
WG215191
BCBSM
MI
Enumeration date
01/13/2006
Last updated
07/21/2022
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