Provider Demographics
NPI:1962543132
Name:GIBSON, MARTHA B (PA-C)
Entity type:Individual
Prefix:
First Name:MARTHA
Middle Name:B
Last Name:GIBSON
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3223 1ST AVE S
Mailing Address - Street 2:SUITE C
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98134-1850
Mailing Address - Country:US
Mailing Address - Phone:206-624-3651
Mailing Address - Fax:206-624-2391
Practice Address - Street 1:3223 1ST AVE S
Practice Address - Street 2:SUITE C
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98134-1850
Practice Address - Country:US
Practice Address - Phone:206-624-3651
Practice Address - Fax:206-624-2391
Is Sole Proprietor?:No
Enumeration Date:2007-02-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPA10002796363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA202528OtherLABOR AND INDUSTRIES