Gibson, Mary E

Gibson, Mary E is an individual health care provider with primary practice located at 4749 Lincoln Mall Dr Ste 204 , Matteson IL 60443-3806. She recently has 2 registered licenses in different health care specialties including Physician Assistants & Advanced Practice Nursing Providers / Nurse Practitioner, Physician Assistants & Advanced Practice Nursing Providers / Adult Health. Physician Assistants & Advanced Practice Nursing Providers / Adult Health is her primary health care specialty. Gibson, Mary E can be contacted via phone (708) 481-4200.

Contact Information

Primary practice address
4749 Lincoln Mall Dr Ste 204 Matteson IL 60443-3806
Phone: (708) 481-4200
Fax: (708) 481-3320
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Physician Assistants & Advanced Practice Nursing Providers / Nurse Practitioner 363L00000X 209-000390 Illinois
Physician Assistants & Advanced Practice Nursing Providers / Adult Health 363LA2200X 209-000390 Illinois

Profile Details

NPI number 1699714907
LBN Legal business name Gibson, Mary E
Credentials Advanced Practice Nurse (APN)
Entity Individual
Sole proprietor 1 No
Enumeration date Jun 5th, 2006
Last updated Nov 15th, 2019 - about 6 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1699714907 NPPES
Illinois Other 01619268 BLUESHIELD NUMBER

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