Provider Demographics
NPI:1316707011
Name:GIBBONS, JORDYN ROCCO
Entity type:Individual
Prefix:MISS
First Name:JORDYN
Middle Name:ROCCO
Last Name:GIBBONS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5 WOLDRIDGE LN
Mailing Address - Street 2:
Mailing Address - City:EAST KINGSTON
Mailing Address - State:NH
Mailing Address - Zip Code:03827-2132
Mailing Address - Country:US
Mailing Address - Phone:603-642-9000
Mailing Address - Fax:
Practice Address - Street 1:5 WOLDRIDGE LN
Practice Address - Street 2:
Practice Address - City:EAST KINGSTON
Practice Address - State:NH
Practice Address - Zip Code:03827-2132
Practice Address - Country:US
Practice Address - Phone:603-642-9000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-20
Last Update Date:2024-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program