Individual
MS. DELORES DARLENE GIBSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
810 BRADWELL DR, COLUMBUS, OH 43207-4160
(614) 491-4141
(614) 409-2722
Mailing address
3821 ARIES BROOK DR, COLUMBUS, OH 43207-4696
(614) 975-8623
Taxonomy
Speciality
Code
Description
License number
State
302F00000X
Exclusive Provider Organization
Primary
2149320
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2149320
INDEPENDENT PROVIDER
OH
Enumeration date
02/22/2007
Last updated
07/08/2007
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