Provider Demographics
NPI:1164837811
Name:GIBSON, SUSAN G (CRNP)
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:G
Last Name:GIBSON
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:701 TECHNOLOGY DR STE 150
Mailing Address - Street 2:
Mailing Address - City:CANONSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:15317-9531
Mailing Address - Country:US
Mailing Address - Phone:412-531-2290
Mailing Address - Fax:412-531-2948
Practice Address - Street 1:3928 WASHINGTON RD STE 220
Practice Address - Street 2:
Practice Address - City:MC MURRAY
Practice Address - State:PA
Practice Address - Zip Code:15317-2594
Practice Address - Country:US
Practice Address - Phone:724-941-8877
Practice Address - Fax:724-941-4745
Is Sole Proprietor?:No
Enumeration Date:2014-06-20
Last Update Date:2021-08-04
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
PASP013902363LP2300X, 363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
No363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care