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Individual

TRACY GIBSON

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
CNM

Contact information

Practice address
500 S 11TH AVE, SUITE 402, POCATELLO, ID 83201-4835
(208) 239-3412
(208) 239-3441
Mailing address
500 S 11TH AVE, SUITE 402, POCATELLO, ID 83201-4835
(208) 239-3412
(208) 239-3441

Taxonomy

Speciality
Code
Description
License number
State
367A00000X
Advanced Practice Midwife
Primary
CNM33
ID

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
000010146389
REGENCE BLUE SHIELD OF ID
ID
05
805053800
ID
01
NPYT9
BLUE CROSS OF IDAHO
ID
01
P00175232
RAILROAD MEDICARE
ID
Enumeration date
08/09/2006
Last updated
03/03/2011
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