Provider Demographics
NPI:1861781825
Name:GIBBONS, MEREDITH KATHLEEN (MSN, CRNP)
Entity type:Individual
Prefix:MS
First Name:MEREDITH
Middle Name:KATHLEEN
Last Name:GIBBONS
Suffix:
Gender:F
Credentials:MSN, CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1519 S CLARION ST
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19147-6209
Mailing Address - Country:US
Mailing Address - Phone:508-846-5642
Mailing Address - Fax:
Practice Address - Street 1:1519 S CLARION ST
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19147-6209
Practice Address - Country:US
Practice Address - Phone:508-846-5642
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-03-30
Last Update Date:2014-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARN623687163W00000X
PASP011308363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
No163W00000XNursing Service ProvidersRegistered Nurse