Individual
MRS. JENNIE LYNN GIBSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
53880 CARMICHAEL DR, SOUTH BEND, IN 46635-1567
(574) 247-9441
Mailing address
3600 W BETHEL AVE, MUNCIE, IN 47304-5407
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
10003788A
IN
363A00000X
Physician Assistant
5601011393
MI
Other
Enumeration date
10/28/2022
Last updated
09/03/2024
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