Provider Demographics
NPI:1528153806
Name:GIBSON, DALE R (APRN)
Entity type:Individual
Prefix:
First Name:DALE
Middle Name:R
Last Name:GIBSON
Suffix:
Gender:M
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1600 S 48TH ST
Mailing Address - Street 2:STE 600
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68506-1283
Mailing Address - Country:US
Mailing Address - Phone:402-483-3333
Mailing Address - Fax:402-483-3297
Practice Address - Street 1:715 N KANSAS AVE
Practice Address - Street 2:SUITE 206
Practice Address - City:HASTINGS
Practice Address - State:NE
Practice Address - Zip Code:68901-4453
Practice Address - Country:US
Practice Address - Phone:402-460-5555
Practice Address - Fax:402-483-3297
Is Sole Proprietor?:No
Enumeration Date:2006-10-04
Last Update Date:2015-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE110258363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE47070592300Medicaid
NE47070592302Medicaid
NE47070592306Medicaid
NE47070592301Medicaid
NE47070592313Medicaid
NE10026072300Medicaid
NE10026072400Medicaid
NE47070592305Medicaid
NE10026072400Medicaid
NENA1080041Medicare PIN
S53948Medicare UPIN
NE47070592305Medicaid
NENA1079029Medicare PIN
NE500010015Medicare PIN