Individual
MICHAEL GIBSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
2250 HICKORY RD STE 240, PLYMOUTH MEETING, PA 19462-2225
(610) 834-1122
Mailing address
108 FAIRVIEW AVE, BALA CYNWYD, PA 19004-1809
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
PN272110
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
PN272110
PA LPN LICENCE
PA
Enumeration date
08/09/2017
Last updated
08/09/2017
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