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Individual
MS. LAWANDA D GIBSON
Active
Individual
MS. LAWANDA D GIBSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PRACTICAL NURSE
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
166730
OH
164W00000X
Licensed Practical Nurse
Primary
4703119637
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
G125488135293
MI STATE DRIVERS LICENSE
MI
Enumeration date
04/03/2020
Last updated
04/03/2020
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