Individual
JACEY GIBBONS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1801 AMBER AVE S, SARTELL, MN 56377-7507
(320) 281-5306
Mailing address
1547 30TH AVE S, MOORHEAD, MN 56560-5149
(218) 287-4338
(218) 287-5928
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
—
—
Other
Enumeration date
02/11/2022
Last updated
12/03/2024
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