1316946874 NPI number — PROF. ELLEN RUTH GIBBS FNP

Table of content: PROF. ELLEN RUTH GIBBS FNP (NPI 1316946874)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1316946874 NPI number — PROF. ELLEN RUTH GIBBS FNP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GIBBS
Provider First Name:
ELLEN
Provider Middle Name:
RUTH
Provider Name Prefix Text:
PROF.
Provider Name Suffix Text:
Provider Credential Text:
FNP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
WINGER
Provider Other First Name:
ELLEN
Provider Other Middle Name:
RUTH
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
FNP
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1316946874
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/16/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5088 N FRESNO ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FRESNO
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
93710-7611
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
559-632-3006
Provider Business Mailing Address Fax Number:
209-725-2072

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5088 N FRESNO ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FRESNO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
93710-7611
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
559-632-3006
Provider Business Practice Location Address Fax Number:
209-725-2072
Provider Enumeration Date:
07/18/2005

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: 363L00000X , with the licence number:  537772 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 239700 , issued by the state of ( OR ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com