Individual
MICHELLE GIBSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CNP
Contact information
Practice address
940 BELMONT ST, BROCKTON, MA 02301-5596
(774) 826-1526
Mailing address
940 BELMONT ST, BROCKTON, MA 02301-5596
(774) 826-1526
Taxonomy
Speciality
Code
Description
License number
State
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
2308106
MA
390200000X
Student in an Organized Health Care Education/Training Program
2308106
MA
Other
Enumeration date
08/10/2016
Last updated
04/28/2017
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