Provider Demographics
NPI:1982124566
Name:GIBSON, DANA (ARNP)
Entity type:Individual
Prefix:
First Name:DANA
Middle Name:
Last Name:GIBSON
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:420 NE GLEN OAK AVE STE 401
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:IL
Mailing Address - Zip Code:61603-3112
Mailing Address - Country:US
Mailing Address - Phone:309-676-8123
Mailing Address - Fax:309-676-8455
Practice Address - Street 1:400 JOHN DEERE RD BLDG 2
Practice Address - Street 2:
Practice Address - City:MOLINE
Practice Address - State:IL
Practice Address - Zip Code:61265-6898
Practice Address - Country:US
Practice Address - Phone:309-517-3036
Practice Address - Fax:309-797-1088
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-23
Last Update Date:2025-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209.016102363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner