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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 |