Provider Demographics
NPI:1316946874
Name:GIBBS, ELLEN RUTH (FNP)
Entity type:Individual
Prefix:PROF
First Name:ELLEN
Middle Name:RUTH
Last Name:GIBBS
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:ELLEN
Other - Middle Name:RUTH
Other - Last Name:WINGER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:FNP
Mailing Address - Street 1:5088 N FRESNO ST
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93710-7611
Mailing Address - Country:US
Mailing Address - Phone:559-632-3006
Mailing Address - Fax:209-725-2072
Practice Address - Street 1:5088 N FRESNO ST
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93710-7611
Practice Address - Country:US
Practice Address - Phone:559-632-3006
Practice Address - Fax:209-725-2072
Is Sole Proprietor?:No
Enumeration Date:2005-07-18
Last Update Date:2020-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA537772363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR239700Medicaid
P04642Medicare UPIN
OR107904Medicare ID - Type Unspecified