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Individual

LAUREN BETH GIBSON

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
PA-C

Contact information

Practice address
4424 E FLAMINGO AVET, STE 110, NAMPA, ID 83687
(208) 302-3200
(208) 302-3255
Mailing address
3340 E GOLDSTONE DR., MERIDIAN, ID 83642
(208) 302-3200
(208) 302-3255

Taxonomy

Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
C50000671
DE
363AM0700X
Medical Physician Assistant
C5-0000671
DE
363AS0400X
Surgical Physician Assistant
C50000671
DE
363AS0400X
Surgical Physician Assistant
Primary
PA-1934
ID

Other

Enumeration date
09/03/2009
Last updated
10/13/2020
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