Provider Information for 1154789568
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HANNAH GIBSON
Sex: Female
NPI: 1154789568
Last Updated: 2016-02-01
Certification Date:
Certification Date:
Details
| Name | Value | ||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| NPI | 1154789568 | ||||||||||||
| Enumeration Date | 2016-02-01 | ||||||||||||
| NPI Type | NPI-1 Individual | ||||||||||||
| Sole Proprietor | YES | ||||||||||||
| Status | Active | ||||||||||||
| Mailing Address | 7509 CHARLESTOWN PIKE CHARLESTOWN, IN 47111-9623 United States Phone: 812-256-4686 | Fax: | ||||||||||||
| Primary Practice Address | 7509 CHARLESTOWN PIKE CHARLESTOWN, IN 47111-9623 United States Phone: 812-256-4686 | Fax: | ||||||||||||
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