Provider Demographics
NPI:1053598458
Name:GIBSON, VIRGINIA (CST)
Entity type:Individual
Prefix:MS
First Name:VIRGINIA
Middle Name:
Last Name:GIBSON
Suffix:
Gender:F
Credentials:CST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:600 ROBBINS RD
Mailing Address - Street 2:SUITE 401
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83702-4539
Mailing Address - Country:US
Mailing Address - Phone:208-383-0201
Mailing Address - Fax:208-489-4300
Practice Address - Street 1:600 ROBBINS RD
Practice Address - Street 2:SUITE 400
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83702-4539
Practice Address - Country:US
Practice Address - Phone:208-383-0201
Practice Address - Fax:208-489-4300
Is Sole Proprietor?:No
Enumeration Date:2008-01-28
Last Update Date:2008-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID96134246ZS0410X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZS0410XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Technologist