Provider Demographics
NPI:1386341162
Name:GIBSON, LINDA (RN)
Entity type:Individual
Prefix:
First Name:LINDA
Middle Name:
Last Name:GIBSON
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:LINDA
Other - Middle Name:
Other - Last Name:MARTINEZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:7050 INFANTRY RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:MANASSAS
Mailing Address - State:VA
Mailing Address - Zip Code:20109-2316
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1137 BRANCHTON RD
Practice Address - Street 2:
Practice Address - City:BOYERS
Practice Address - State:PA
Practice Address - Zip Code:16020-1400
Practice Address - Country:US
Practice Address - Phone:800-899-4766
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-02-13
Last Update Date:2023-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMRN77799163W00000X
PARN750034163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse