Provider Demographics
NPI:1730578386
Name:GIBSON, JANELLE (APN)
Entity type:Individual
Prefix:
First Name:JANELLE
Middle Name:
Last Name:GIBSON
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2010 SPRINGFIELD AVE
Mailing Address - Street 2:
Mailing Address - City:MAPLEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:07040-2163
Mailing Address - Country:US
Mailing Address - Phone:973-275-9500
Mailing Address - Fax:973-275-9501
Practice Address - Street 1:2010 SPRINGFIELD AVE
Practice Address - Street 2:
Practice Address - City:MAPLEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:07040-2163
Practice Address - Country:US
Practice Address - Phone:973-275-9500
Practice Address - Fax:973-275-9501
Is Sole Proprietor?:Yes
Enumeration Date:2015-01-20
Last Update Date:2016-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ00547800363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care