Provider Demographics
NPI:1104350602
Name:GIBSON, JULIE MARIE (RN)
Entity type:Individual
Prefix:MS
First Name:JULIE
Middle Name:MARIE
Last Name:GIBSON
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:9005 SUNNY BROOK ST NE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87113-2112
Mailing Address - Country:US
Mailing Address - Phone:505-262-3851
Mailing Address - Fax:505-262-7040
Practice Address - Street 1:5150 JOURNAL CENTER BLVD NE
Practice Address - Street 2:DAVITA MEDICAL GROUP COUMADIN CLINIC
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87109-5900
Practice Address - Country:US
Practice Address - Phone:505-262-3851
Practice Address - Fax:505-262-3851
Is Sole Proprietor?:No
Enumeration Date:2017-04-12
Last Update Date:2017-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMR47027163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse