1164651725 NPI number — JENNIFER KATHRYN GIBSON-SNYDER MD

Table of content: JENNIFER KATHRYN GIBSON-SNYDER MD (NPI 1164651725)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1164651725 NPI number — JENNIFER KATHRYN GIBSON-SNYDER MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GIBSON-SNYDER
Provider First Name:
JENNIFER
Provider Middle Name:
KATHRYN
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1164651725
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/20/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
P. O. BOX 34439
Provider Second Line Business Mailing Address:
PROVIDENCE HEALTH AND SERVICES, MT
Provider Business Mailing Address City Name:
SEATTLE
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98214-1439
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
500 W. BROADWAY
Provider Second Line Business Practice Location Address:
PROVIDENCE SAINT PATRICK HOSPITAL
Provider Business Practice Location Address City Name:
MISSOULA
Provider Business Practice Location Address State Name:
MT
Provider Business Practice Location Address Postal Code:
59802-4008
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-680-1361
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/04/2009

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X , with the licence number:  ML60093524 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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