Provider Demographics
NPI:1326212325
Name:GIBBAR, ANGELA RAE (CRNA)
Entity type:Individual
Prefix:
First Name:ANGELA
Middle Name:RAE
Last Name:GIBBAR
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 540
Mailing Address - Street 2:
Mailing Address - City:WEST BURLINGTON
Mailing Address - State:IA
Mailing Address - Zip Code:52655-0540
Mailing Address - Country:US
Mailing Address - Phone:319-768-1000
Mailing Address - Fax:319-768-3460
Practice Address - Street 1:1221 S GEAR AVE
Practice Address - Street 2:
Practice Address - City:WEST BURLINGTON
Practice Address - State:IA
Practice Address - Zip Code:52655-1679
Practice Address - Country:US
Practice Address - Phone:319-768-1000
Practice Address - Fax:319-768-3460
Is Sole Proprietor?:No
Enumeration Date:2008-04-22
Last Update Date:2008-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAD119292367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
IAP00623366OtherRR MEDICARE
IA1326212325Medicaid
IA1326212325OtherWELLMARK BLUE CROSS BLUE SHIELD
IAI43730008Medicare PIN