1952184780 NPI number — BROOKE ANN GIBSON DNP, APRN, FNP-C

Table of content: BROOKE ANN GIBSON DNP, APRN, FNP-C (NPI 1952184780)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1952184780 NPI number — BROOKE ANN GIBSON DNP, APRN, FNP-C

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GIBSON
Provider First Name:
BROOKE
Provider Middle Name:
ANN
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
DNP, APRN, FNP-C
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1952184780
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/27/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
84-965 FARRINGTON HWY APT 404
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WAIANAE
Provider Business Mailing Address State Name:
HI
Provider Business Mailing Address Postal Code:
96792-2035
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
503-351-0031
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3110 KERNER BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SAN RAFAEL
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
94901-5411
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
808-697-3517
Provider Business Practice Location Address Fax Number:
808-697-3155
Provider Enumeration Date:
08/15/2023

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363LF0000X , with the licence number:  APRN-4188-0 , registered in the state of HI ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363LF0000X , with the licence number: 95031357 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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