Individual
MARY E GIBSON
Active
Individual
MARY E GIBSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
APN
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
209-000390
IL
363LA2200X
Adult Health Nurse Practitioner
Primary
209-000390
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
01619268
BLUESHIELD NUMBER
IL
Enumeration date
06/05/2006
Last updated
11/15/2019
Update your record
If you believe information in your NPPES record is inaccurate, or if you wish to update or deactivate your NPI, you can do so directly with CMS at https://nppes.cms.hhs.gov.
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