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Carol Ann Jackson-Gibson

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NPI Number Detailed Information

Provider Information:

Name: Carol Ann Jackson-Gibson
Gender: F
Provider License Number If Given: 176786

NPI Information:

NPI: 1164421442
Entity Type
(Individual or Organization):
1-ind
Enumeration Date: 7/19/2005

Last Update Date: 3/11/2013

Provider Business Mailing Address:

Address: 1150 YOUNGS RD SUITE 111
Williamsville, NY 14221
Phone Number: 7166887622
Fax Number: 7166887592

Provider Business Practice Location Address:

Address: 1150 YOUNGS RD SUITE 111
Williamsville, NY 14221
Phone Number: 7166887622
Fax Number: 7166887592

Provider Taxonomy:

Primary: 2085N0904X
Secondary (if any): 2085R0202X
State: NY

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