Individual
REGINA GIBSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
342 NORTH ST, SUITE D, MURPHYSBORO, IL 62966-2250
(618) 565-2835
Mailing address
342 NORTH ST, SUITE D, MURPHYSBORO, IL 62966-2250
(618) 565-2835
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
043057646
IL
Other
Enumeration date
09/27/2016
Last updated
09/27/2016
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