Individual
MR. EDWARD BROOKE GIBSON II
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CPNP-AC
Contact information
Practice address
3401 CIVIC CENTER BLVD, PHILADELPHIA, PA 19104-4319
(800) 879-2467
Mailing address
214 W BROOKHAVEN RD, BROOKHAVEN, PA 19015-1638
(504) 957-0319
Taxonomy
Speciality
Code
Description
License number
State
363LP0200X
Pediatric Nurse Practitioner
Primary
SP021857
PA
Other
Enumeration date
04/17/2020
Last updated
04/17/2020
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