Individual
THAD GIBLETTE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
FNP
Contact information
Practice address
2315 8TH ST, LEWISTON, ID 83501-7301
(208) 746-1383
(208) 746-6348
Mailing address
2315 8TH ST, LEWISTON, ID 83501-7301
(208) 746-1383
(208) 746-6348
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
59480
ID
363L00000X
Nurse Practitioner
AP60910202
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1699819292
—
ID
05
—
1699819292
—
WA
Enumeration date
02/16/2007
Last updated
12/05/2018
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